Autoimmune hemolytic anemia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S; Shyam Patel [2]

Classification

Category	Features	Subtypes
Warm-antibody type	Accounts for ~75% of cases of autoimmune hemolytic anemia Due to IgG autoantibody Binding occurs optimally at 37 degrees Celsius Extravascular hemolysis (reticuloendothelial system)	Idiopathic Systemic lupus erythematosus Evans' syndrome Chronic lymphocytic leukemia Non-Hodgkin lymphoma Drugs (methyldopa)
Cold-antibody type	Accounts for ~25% of cases of autoimmune hemolytic anemia Due to IgM autoantibody Binding occurs optimally at 4 degrees Celsius Intravascular hemolysis Recognition by the reticuloendothelial system Destruction by macrophages	Cold agglutinin disease Paroxysmal cold hemoglobinuria Mycoplasma infection Malignancy
Mixed warm-antibody and cold-antibody type	Due to IgM subtype Mixed features	Various clinical entities Generally rare

Intravascular haemolysis
Red blood cell lysis occurs in the circulation as a result of activation of the complement system cascade.

Extravascular haemolysis
Red Blood Cells that are coated with antibodies are specifically recognised in the reticuloendothelial system and destroyed by macrophages.

Subtypes

• Warm antibody autoimmune hemolytic anemia

• Idiopathic
• Systemic lupus erythematosus
• Evans' syndrome (antiplatelet antibodies and haemolytic antibodies)
• Chronic lymphocytic leukemia
• Drugs (methyldopa)

• Cold antibody autoimmune hemolytic anemia

• Idiopathic cold hemagglutinin syndrome
• Infectious mononucleosis
• Paroxysmal cold hemoglobinuria (rare)
• Lymphoma

• Mixed-type autoimmune hemolytic anemia

References

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