Autoimmune hemolytic anemia in children during 2004–2014 in the Department of Pediatrics, Hematology and Oncology, Warsaw Medical University
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Department of Pediatrics, Hematology and Oncology, Warsaw Medical University, Poland
Department of Laboratory Diagnostics and Clinical Immunology, Warsaw Medical University, Poland
Department of Immunology, Institute of Hematology and Transfusion Medicine, Poland
Submission date: 2014-10-01
Acceptance date: 2015-04-30
Online publication date: 2015-08-05
Publication date: 2020-03-26
Corresponding author
Magdalena Wołowiec   

Department of Pediatrics, Hematology and Oncology, Warsaw Medical University, Marszałkowska 24, 00-576 Warsaw, Poland. Tel.: +48 22 5227438.
Pol. Ann. Med. 2015;22(2):119-123
Autoimmune hemolytic anemia (AIHA) is a rare disorder in which the immune system produces pathologic antibodies directed against its own red blood cells (autoantibodies). AIHA is most commonly diagnosed by a positive result of the direct antiglobulin test (DAT, Coombs test). Depending on the temperature at which autoantibodies react with red blood cells in vitro AIHA is classified as warm-type AIHA with incomplete IgG autoantibodies and cold-type AIHA with cold IgM agglutinins (CAS – cold agglutinin syndrome) or with biphasic hemolysins (PCH – paroxysmal cold hemoglobinuria). In mixed-type AIHA there are simultaneously warm autoantibodies and cold agglutinins.

The aim of this study was to find the number and types of AIHA diagnosed and treated in the Department of Pediatrics, Hematology and Oncology of Warsaw Medical University during the years 2004–2014.

Material and methods:
The authors analyzed 54 children in which AIHA was diagnosed. The age of the child at diagnosis, the result of direct antiglobulin test and the type of autoantibodies in serum were taken into account.

Results and discussion:
The most common type of AIHA in a group covered by the survey was cold-type AIHA, including paroxysmal cold hemoglobinuria (37%) and cold agglutinin syndrome (16%).

As far as the results are concerned, avoidance of cold is essential before the serological diagnosis is reached.

None declared.
Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am J Hematol. 2002;69(4):258–271.
Petz LD, Garratty G. The diagnosis of hemolytic anemia. In: Immune Hemolytic Anemia. 2nd ed. Philadelphia: Churchill Livingstone; 2004:33–60.
Sokol RJ, Booker DJ, Stamps R. The pathology of autoimmune haemolytic anaemia. J Clin Pathol. 1992;45(12):1047–1052.
Wołowiec M. Haematological changes depending on the age of the child. Pediatr Dypl. 2014;18(1):7–13 [in Polish].
Fabijańska-Mitek J, Gonera G, Palynyczko G. Severe ‘‘Coombs negative’’ autoimmune haemolytic anaemia. Acta Haematol Pol. 1999;30:83–87.
Adamowicz-Salach A. Congenital and acquired hemolytic anemia – diagnostic and therapeutic procedures. Pediatr Dypl. 2013;17(5):28–37 [in Polish].
Brain B, Bates J, Laffan M, Lewis S, eds. In: Dacie and Lewis Practical Hematology 11th ed. Elsevier; 2011.
Michalewska B. Autoimmune hemolytic anemias – significance of detailed laboratory testing for diagnosis of rare cases. Acta Haematol Pol. 2009;40(2):463–474 [in Polish].
Petz LD, Garratty G. Classification and characteristics of autoimmune hemolytic anemias. In: Immune Hemolytic:A6n1e–m13ia1.. 2nd ed. Philadelphia: Churchill Livingstone; 2004.
Petz LD, Garratty G. Differential diagnosis of immune hemolytic anemias. In: Immune Hemolytic Anemia. 2nd ed. Philadelphia: Churchill Livingstone; 2004:167–195.
Mayer B, Yürek S, Kiesewetter H, Salama A. Mixed-type autoimmune hemolytic anemia: differential diagnosis and a critical review of reported cases. Transfusion. 2008;48(10):2229–2234.
Blackall DP. Warm-reactive autoantibodies in pediatric patients: clinical and serologic correlations. J Pediatr Hematol Oncol. 2007;29(11):792–796.
Göttsche B, Salama A, Mueller-Eckhardt C. Donath-Landsteiner autoimmune hemolytic anemia in children. A study of 22 cases. Vox Sang. 1990;58(4):281–286.
Adamowicz-Salach A, Borodzińska E, Rokicka-Milewska R. Extremely severe Evans syndrome: diagnostic problems. Int J Hematol Oncol. 2001;7(5–6):401–406.
Fabijańska-Mitek J, Pogłód R, Adamowicz-Salach A, Łopieńska H. Quantitation of red cell-bound IgG by an enzyme-linked antiglobulin test in the patients with warm-type autoimmune hemolytic anaemia. Clin Lab Haematol. 2006;28(4):241–244.
Packman CH. Hemolytic anemia due to warm autoantibodies. Blood Rev. 2008;22(1):17–31.
Petz LD, Garratty G. Mechanism of immune hemolysis. In: Immune Hemolytic Anemia. 2nd ed. Philadelphia: Churchill Livingstone; 2004:133–166.
Garvey B. Rituximab in the treatment of autoimmune haematological disorders. Br J Haematol. 2008;141(2):149–169.
Sobocińska-Mirska A, Adamowicz-Salach A, Michalewska B, et al. Paroxysmal cold hemoglobinuria as underestimated cause of autoimmune hemolytic anemia in children. Pediatr Pol. 2009;84(1):46–52 [in Polish].
Seltsam A, Shukry-Schulz S, Salama A. Vaccinationassociated immune hemolytic anemia in two children. Transfusion. 2000;40(8):907–909.
Shizuma T. Autoimmune hemolytic anemia following influenza virus infection or administration of influenza vaccine. J Blood Disord Transfus. 2014;5:200.
Petz LD. Cold antibody autoimmune hemolytic anemias. Blood Rev. 2008;22(1):1–15.
Sokol RJ, Booker DJ, Stamps R. Erythropoesis: paroxysmal cold haemoglobinuria: a clinicopathological study of patients with a positive Donath-Landsteiner test. Hematology. 1999;4(2):137–164.
Koppel A, Lim S, Osby M, Garratty G, Goldfinger D. Rituximab as successful therapy in a patient with refractory paroxymal cold hemoglobinuria. Transfusion. 2007;47(10):1902–1904.
Berentsen S, Beiske K, Tjonnfjord GE. Primary chronic cold agglutinin disease: an update on pathogenesis, clinical features and therapy. Hematology. 2007;12(5):361–370.
Morselli M, Luppi M, Potenza L, et al. Mixed warm and cold autoimmune hemolytic anemia: complete recovery after 2 courses of rituximab treatment. Blood. 2002;99(9):3478–3479.
Żupańska B, Ławkowicz W, Górska W, et al. Autoimmune haemolytic anemia in children. Br J Haematol. 1976;34(3):511–520.
Żupańska B, Ławkowicz W, Górska B, et al. Autoimmune hemolytic anemia in children. Br J Haematol. 1977;52(12):1333–1342 [in Polish].
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