Autoimmune hemolytic anemia
Hemolytic anemia is a set of both innate and acquired diseases characterized by destruction of red blood cells or inside the cells within the vessels. Autoimmune hemolytic anemia (AHA for short) - the most common kind of hemolytic anemia.
Autoimmune hemolytic anemia: etiology, pathogenesis, classification and clinical picture
Hemolytic anemia can develop due to the conflict of blood group or Rh factor between mother and fetus or by blood transfusion. They are called isoimmune.
The second group includes cases where the body's own immune system produces antibodies against its own erythrocytes. They are called autoimmune hemolytic anemia. When conducting diagnostic blood test in patients with AGA immunoglobulins IgG (rarely IgM and IgA) show a deviation from the norm.
In most cases, autoimmune hemolytic anemia found in a variety of specific and nonspecific symptoms compared to other blood disorders; They can occur in an acute form and a chronic process.
In severe cases, the disease begins with weakness, shortness of breath and palpitations, fever, vomiting, and marked jaundice, pain in the heart and in the lower back.
Chronic autoimmune hemolytic anemia often occurs practically asymptomatic with periodic exacerbations. Against the background of remission noted an increase in liver and spleen palpation, often jaundice.
In a detailed analysis of the blood in patients with AGA note, in particular, normal or elevated hemoglobin, increased erythrocyte sedimentation rate, normal platelet count. In acute and acute exacerbations of chronic flow increases the number of leukocytes, whereas in remission of their level is normal.
The diagnosis of "autoimmune hemolytic anemia" often more accurately differentiates experts after the specific diagnostic tests.
Types of treatment of autoimmune hemolytic anemia
Tactics of treatment of autoimmune hemolytic anemia in acute illness or exacerbation of chronic process necessarily involves hormone therapy. The average daily dose of 60-80 mg of prednisone is divided into three portions in a ratio of 3: 2: 1. In the case of treatment failure, it can be increased to 150 mg and up, and for the improvement of the patient - is gradually reduced (2, 5-5 mg per day in order to avoid recurrence) to half the initial first dosage and further up to the full drug withdrawal .
In chronic course of the disease, the treatment of autoimmune hemolytic anemia requires the appointment of prednisolone, but a daily dose of 20-25 mg. The drug is under laboratory control, and as the normalization of the blood the dose gradually reduced to maintenance - 5-10 mg per day.
Sometimes appropriate and justified in the treatment of AGA is the appointment of the group of immunosuppressive drugs, and in severe hemolytic crisis shows infusion therapy: individually matched erythrocyte mass gemodez etc. for intoxication. Sometimes transfused blood plasma, washed or frozen red cells, have resorted to the method of dialysis (artificial kidney) and prazmofereza (removal of the liquid part of blood - plasma - together with antibodies).
A number of patients with AGA has high resistance to hormonal therapy. The disease is characterized by frequent relapses have practically defies medical correction. For the treatment of AHA in these patients used radical treatment - splenectomy (removal of the spleen), which significantly improves the quality of life.
Despite the high level of development of modern medicine treatment of hemolytic anemia is very difficult, and the diagnosis is often poor.