DIAGNOSIS
Your doctor will explain to you broadly about your specific symptoms if they think you have AIHA. They’ll need to diagnose you with AIHA and exclude medications or other underlying disorders as the possible causes of the AIHA before diagnosing you with the idiopathic type.
First, they will ask some questions regarding your medical history. It’s likely they’ll admit you to a hospital for immediate testing and monitoring if your symptoms are severe. For example, they will refer you to a blood specialist or a hematologist if serious issues including bloody urine, discolored skin, or severe anemia occurs.
You’ll need to have an extensive series of blood tests to confirm AIHA. Some of these tests will measure the body’s red blood cell count. If you are positive for AIHA, your red blood cell count number will be low. Other tests will look for definite substances in the blood. Blood tests will show an incorrect ratio of immature to mature red blood cells that can then diagnose AIHA. A high number of immature red blood cells show that the body is trying to bring back the red blood cells that are being destroyed too quickly.
Haptoglobin is a blood test that finds abnormally high levels of bilirubin and decreased levels of protein. Bilirubin is a natural by-product of red cell breakdown. The haptoglobin blood test can be very useful in diagnosing AIHA. These levels become high when large numbers of red blood cells are destroyed. In synchronicity with other blood tests, it shows that the protein is being destroyed, along with mature red blood cells.
In some circumstances, the usual lab results for these blood tests may not be enough to determine AIHA, so your doctor may need you to undergo more tests. Other tests include direct and indirect Coombs test. This can detect high antibodies in the blood. Urinalysis and a 24-hour urine collection may reveal abnormalities in the urine, such as high levels of protein.
TREATMENT
People suspected of having sudden idiopathic AIHA will generally be hospitalized immediately because of its acute nature. Without explanation, it may often come and go. There’s a possibility that it can improve without treatment.
Your doctor will observe your blood glucose levels closely if you have diabetes. It is a major risk factor for deaths from infection as a result of treatment.
Steroids
The preferred treatment is usually steroids such as prednisone. This may help improve red blood cell count. Your doctor will observe you closely to check whether the steroids are working. Once your condition goes into remission, your doctor will try to taper steroids slowly. People with AIHA undergoing steroid therapy may need supplements during treatment. These include:
- Bisphosphonates
- Vitamin D
- Calcium
- Folic acid
- Surgery
If steroids don’t work, the doctor may recommend surgical removal. This surgery is known as splenectomy. The removal of the spleen can reverse the destruction of red blood cells. Some people who undergo splenectomy have a partial or total remission from their AIHA, and people with the idiopathic type tend to have the most successful results.
Immune-suppressing drugs
Immune-suppressing drugs can be effective medications for people who don’t successfully respond to treatment with steroids or who aren’t candidates for surgery. Examples of immune-suppressing drug are azathioprine and cyclophosphamide.
Rituximab is an antibody that directly attacks specific proteins found on certain immune system cells. In some cases, the medication rituximax may be preferred over the tradional immune-suppressing drugs.
Treatment is sometimes delayed in these cases. It can be difficult to get a quick diagnosis of this condition because it may be unrecognizable. Idiopathic AIHA can be fatal if left untreated.
Children who have idiopathic AHIA are usually short-lived. The condition is often persistent in adults, and can flare up or reverse itself without explanation. AIHA is highly curable in both adults and children. Most people make a full recovery.
