Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

Immune Hemolytic Anemia 813

■CAHA

■general signs and symptoms; intravscular/extravascular hemolysis;

red cell agglutination leads to acrocyanosis in the cooler distal areas

of the body

■severity depends on the titer and thermal amplitude of the autoan-

tibody

■PCH

■general signs and symptoms; intravascular hemolysis; accompanied

by cold urticaria and abdominal pain

■MTHA

■general signs and symptoms; extravascular hemolysis is often severe

and chronic with intermittent exacerbations

■DIHA

■general signs and symptoms; extravascular or intravascular hemol-

ysis

tests

Basic Blood Tests

■General

➣anemia, decreased haptoglobin, increased LDH, increased

unconjugated bilirubin, increased reticulocyte count, increased

free hemoglobin

Basic Urine Tests

■General

➣hemoglobinuria, hemosiderinuria, increased urobilinogen

Other Tests

■General

➣peripheral smear: macrocytosis, polychromasia, spherocytosis,

schistocytosis, nucleated red blood cells, red blood cell aggluti-

nation

➣bone marrow: erythroid hyperplasia, infiltration by neoplasm

Specific Diagnostic Tests

■WAHA

■DAT: positive for IgG; false positive rate up to 15% of hospitalized

patients; negative result does not rule out WAHA

■indirect antiglobulin (Coombs) test (IAT): performed on serum

and/or red blood cell eluate; positive for IgG panagglutinin; approx-

imately 50% of warm-reactive autoantibodies have specificities

within the Rh antigen system