Autoimmune hemolytic anemia is a condition where the immune system mistakenly attacks normal red blood cells by producing antibodies. This destruction causes a decrease in red blood cells, leading to anemia. Fortunately, it can be diagnosed and treated.
The causes of autoimmune hemolytic anemia are classified into two categories: primary and secondary. The primary cause is unknown and accounts for half of the cases. The secondary form is linked to other conditions or factors. There are two types of secondary autoimmune hemolytic anemia: warm-type and cold-type.
Warm-type anemia can result from conditions like systemic lupus erythematosus, scleroderma, Crohn’s colitis, rheumatoid arthritis, and lymphoproliferative disorders such as chronic lymphocytic leukemia and lymphoma. Infections and non-lymphoid cancers can also occasionally cause warm-type anemia. On the other hand, cold-type anemia is often triggered by lymphoproliferative disorders or infections like viral pneumonia, infectious mononucleosis, and mycoplasma.
The symptoms of autoimmune hemolytic anemia include pale skin, fatigue, dizziness, heart palpitations, shortness of breath, and in severe cases, loss of consciousness or death. The breakdown of red blood cells releases bile into the bloodstream, which may lead to jaundice, itchy skin, and dark urine.
During pregnancy, women can experience physiological anemia, which occurs not from the destruction of red blood cells but their dilution due to increased plasma volume starting around the second or third month. This type of anemia is managed with iron supplements to boost red blood cell production.
Clinical studies up to 2015 show that autoimmune hemolytic anemia related to pregnancy is not well documented. Most reported cases occur in late pregnancy and respond well to steroid treatment, sometimes with blood transfusions, and generally without harming the baby. Occasionally, the condition resolves on its own after pregnancy.
Autoimmune hemolytic anemia during pregnancy can be risky for both mother and fetus, especially if the antibodies are of the immunoglobulin G type, as these can cross the placenta. While some therapies are effective in reducing the autoimmune response, they don’t always work. For instance, in one case, despite treatment, the fetus did not respond, and the baby was delivered early. The mother then underwent spleen removal, a treatment used in non-pregnant patients. Both mother and baby recovered well after delivery and subsequent treatments.
In another study, two women diagnosed with warm-type autoimmune hemolytic anemia in the late third trimester responded well to steroid therapy, and their babies were born healthy without signs of hemolysis.
The key takeaway is that autoimmune hemolytic anemia is treatable. Recognizing the symptoms and understanding how they can affect pregnancy is crucial. More research is needed to fully understand the condition, but the main goal of treatment is to stop the breakdown of red blood cells and correct the anemia.