Abstract

Background: Diagnosing patients of autoimmune hemolytic anemia (AIHA) requires an evaluation of history, clinical features and laboratory findings. In cases requiring transfusion, while serological incompatibility often makes it difficult and time-consuming to find a best match unit, it should not be an indication to withhold transfusion.

Objectives: To study the clinicopathological profile, transfusion requirements and challenges of patients of AIHA diagnosed and managed at our hospital over one year (January-December 2017).

Material and Methods: This is a descriptive retrospective study. The diagnosis of AIHA was based on- demographics and history, presenting features and hematological and biochemical findings. Tests performed-direct and indirect antiglobulin test (DAT, IAT) ,cold agglutinin titer (CAT); Hematological and biochemical indicators of in vivo hemolysis- hemoglobin, reticulocyte count, total  serum bilirubin and serum lactate dehydrogenase (LDH). All data were obtained from patient records. Patients were divided into 2 categories- severe and moderate hemolysis. Packed red cell transfusions for these patients, including incompatible cross matches were documented.

Results: Of 185 DAT positive cases, 44 patients aged between 1 and 68years (M:F = 1:2.6) were diagnosed as AIHA with a peak incidence in the third decade. Of these, as per our criteria, moderate and severe hemolysis was shown by 29 and 15 patients respectively. Pallor was the commonest presenting feature. 19(43%) patients had AIHA secondary to another cause, infection being the commonest. Patients showed good correlation of severity of clinical features with degree of derangement of laboratory parameters. Hb was <8gm/dL in both categories with 19 patients showing severe anemia (<5gm/dL). Mean serum Bilirubin, LDH and reticulocyte count were also deranged in both categories. Concomitant IAT and CAT positivity were seen in 24 and 2 cases respectively. 179 units of PRBCs were crossmatched for these 44 cases in the study period. Of these, 84 (47%) units were designated as “least incompatible”. Ultimately  57 units were transfused to 22(50% of total) patients- 3 patients with severe hemolysis received 15 units in total(5units/patient) and 19 patients with moderate hemolysis used 42 units in total(2.2 units/patient). C:T ratio- 2.6

Conclusion: Diagnosis of AIHA is a multipronged approach. In general, degree of hemolysis, clinical and laboratory parameters and transfusion requirements correlate well. Besides DAT positivity, IAT and CAT can also be positive, making finding “best match” units in such cases difficult. Only about 50% of patients were transfused, while the rest were managed with supplementary modalities. Serological incompatibility can adversely affect turnaround time of issue and blood utilization but should not be a reason to not transfuse. 

Keywords: Autoimmune hemolytic anemia, transfusion, Direct Antiglobulin Test.