A rare disorder that damages your red blood cells is called warm hemolytic anemia. It produces symptoms that resemble anemia, including paleness, jaundice, and exhaustion.
Red blood cell lysis in warm hemolytic anemia occurs at body temperature. With other kinds of hemolytic anemias, this isn’t always the case.
About 1 to 3 persons out of every 100,000 are affected by this extremely rare illness annually. Sometimes physicians are unable to determine the cause.
It could be fatal without therapy, but early intervention can be quite successful in producing remission.
Learn more about warm hemolytic anemia by continuing to read.
What is it?
Warm hemolytic anemia is the result of your body misinterpreting red blood cells for something toxic. Anemia results from the antibodies it creates attacking and prematurely destroying the cells.
The oxygen-carrying red blood cells in our bodies typically have a life span of 120 days. They live less time, nevertheless, if they have warm hemolytic anemia. This indicates that the body’s rate of cell lysis exceeds its rate of cell production. An erratic heartbeat, exhaustion, and impaired focus may result from this.
Unlike other forms of hemolytic anemia, warm hemolytic anemia is characterized by the antibodies’ reaction to body temperature. Other variations of the illness have varying temperature ranges.
Signs and symptoms
At first, the symptoms may not be noticeable, and they frequently resemble those of general anemia.
Among the symptoms to watch out for are:
- fatigue
- paleness
- poor concentration
- headache
- shortness of breath
If the illness worsens, the following symptoms indicate more severe anemia:
- jaundice, or yellowing of the skin and eyes
- dark urine
- increased blood levels of lactate dehydrogenase and bilirubin
Individuals with a severe variant of the illness are more susceptible to pulmonary embolism and deep vein thrombosis.
Causes and risk factors
Antibodies that target red blood cells at body temperature levels cause warm hemolytic anemia.
There isn’t a clear underlying reason for this in roughly half of the situations. However, in some cases, there might be a connection to another autoimmune disease, like:
- rheumatoid arthritis
- thyroid diseases
- ulcerative colitis
- lupus
Furthermore, cases involving individuals who have experienced:
- chronic lymphocytic leukemia
- non-Hodgkin’s lymphoma
- recent organ transplants
- cancer treatments
Although the illness can strike anyone at any age, persons between the ages of 50 and 70 are more likely to have it. It usually manifests at about 52 years of age.
Diagnosis
A diagnosis can only be made using blood tests.
A complete blood count (CBC) will be the first test your doctor orders if they suspect warm hemolytic anemia. This test will reveal any anemia warning signals. It will examine your hematocrit, hemoglobin (a blood protein), platelet count, and red and white blood cells.
If a CBC shows anemia, your doctor will order more testing. These examinations could consist of:
- Reticulocyte count: This represents the number of immature red blood cells in your blood. If it’s elevated, your bone marrow is actively trying to replace the lost cells.
- Lactase dehydrogenase: An enzyme called this one is found in red blood cells. When the body breaks down red blood cells, this level increases.
- Bilirubin test: The liver produces bilirubin, and when red blood cells are damaged, the amount of this substance increases.
- Haptoglobin test: Waste from damaged red blood cells is eliminated by this protein. These will be low if your hemoglobin is running low.
- DAT: This direct antiglobulin test, also known as the Coombs test, can determine whether your body is producing antibodies against your red blood cells.
- Eluate assessment: The red blood cell membrane is studied in this lab experiment. It can validate the diagnosis of warm autoimmune hemolytic anemia based on its response.
- Peripheral blood smear: To determine whether your body is eliminating blood cells, this test looks at your blood under a microscope.
Warm vs. cold hemolytic anemia
The most prevalent kind of autoimmune hemolytic anemia is called warm hemolytic anemia.
More uncommon is cold agglutinin illness, which is another name for cold hemolytic anemia. Red blood cells in this condition are destroyed by antibodies at lower temperatures, often between 37°F and 39°F (3°C and 4°C).
In addition to being comparable to those of warm hemolytic anemia, the symptoms of cold hemolytic anemia might also include:
- cold hands and feet
- chest pain
- Raynaud phenomenon
- cardiac arrhythmias
Compared to warm hemolytic anemia, cold hemolytic anemia will have different causes and available treatments.
Treatment
Treating any underlying medical issues may occasionally help to alleviate warm hemolytic anemia symptoms. It might not require therapy in extremely mild cases when there is no underlying illness.
In other cases, the following range of treatments can help control the illness or induce remission:
- Corticosteroids: According to a 2022 study, corticosteroids are frequently used as a first-line treatment for the illness and can be successful in 85% of cases. Nevertheless, prolonged usage could result in significant adverse effects, and less than one-third of patients continue to respond well after ceasing corticosteroid therapy.
- Rituximab: Rituximab is used to treat a few autoimmune diseases. According to the same paper, more than 75% of patients with warm hemolytic anemia may have remission as a result. It can be helpful for people whose illness stops responding to corticosteroids, and its effects might be long-lasting.
- Immunosuppressants: If rituximab is not accessible or does not function, immunosuppressants may be able to help. The 2022 study claims that these drugs benefit more than half of patients whose illness is unresponsive to rituximab.
- Splenectomy: Although spleen ectomy is typically the last resort, in more than two-thirds of cases, it can result in long-term remission. But it’s a less common choice. This is due to the increased risk of infection.
- Newer medications: Although they aren’t yet generally accessible, emerging medications including fostamatinib, rilzabrutinib, and FcRn inhibitors are demonstrating promise as treatments.
When to contact a doctor
Warm hemolytic anemia in mild cases frequently shows no symptoms. If you start to see symptoms of your anemia getting worse, like these, you should see a doctor.
- dark urine
- jaundice
- increased fatigue
- extreme paleness
- dizziness or confusion
The bottom line
A rare disorder known as warm hemolytic anemia causes your body to attack red blood cells at body temperature. Paleness, jaundice, increased fatigue, and dark urine are some of the symptoms that might result from this fast breakdown of red blood cells.
At times, the ailment appears to have no apparent explanation, while at other times it is connected to an underlying autoimmune disorder.
Corticosteroids are typically the first line of treatment, however, immunosuppressants and rituximab may also be useful. An extended remission is achievable with prompt diagnosis and therapy.