autoimmune hemolytic anemia
Introduction
Introduction to autoimmune hemolytic anemia Autoimmune hemolytic anemia (AIHA) is a group of B lymphocyte dysfunction, producing anti-erythrocyte antibodies, anemia caused by increased destruction of red blood cells. Sometimes the destruction of red blood cells can be compensated by the formation of bone marrow erythropoiesis, and there is no clinical anemia, that is, only autoimmune hemolysis (AIH). Others can only measure anti-self red blood cell antibodies (AI) without obvious signs of hemolysis. Evans is called when the body produces both anti-self-erythrocyte antibodies and anti-self-platelet antibodies (even leukocyte antibodies), which in turn causes anemia and thrombocytopenia (or whole cell reduction). The clinical manifestations of this disease are multi-terminal, warm antibody type AIHA is mostly chronic onset, easy to repeat, some patients have a history of acute attacks, chills, fever, jaundice, back pain, etc., hemoglobinuria is common in paroxysmal coldness Hemoglobinuria is rare in cold agglutinin disease, often repeated, and difficult to control later. basic knowledge The proportion of sickness: 0.0155% - 0.0228% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia
Cause
Cause of autoimmune hemolytic anemia
Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, scleroderma, ulcerative colitis, myasthenia gravis, autoimmune thyroiditis, hypogammaglobulinemia, abnormal globulinemia, pernicious anemia, Immune-related pure red blood cell aplasia, autoimmune liver disease, etc.
Neoplastic diseases: lymphoma, leukemia, plasma cell disease, histiocytosis, certain solid tumors, etc. Primary AIHA has no clear cause of AIHA as primary AIHA, and domestic reports account for 39.7% to 58.7%.
Infection: Secondary AIHA AIHA can be secondary to various viral infections, mycoplasma pneumonia, tuberculosis, subacute bacterial endocarditis, syphilis, etc. in the following diseases.
Prevention
Autoimmune hemolytic anemia prevention
Prevention : cold agglutinin disease, cold hemoglobinuria patients should avoid cold, the usual naked parts should not be ignored, there is no obvious incentive for the onset of warm antibody type AIHA hemolysis, some patients with seizures related to trauma, surgery, pregnancy, mental stimulation Should try to avoid, explain the basic concept of the disease to patients, prevention and treatment points, explain the importance of prevention and implementation methods, encourage patients to self-train and nurse under the conditions of adequate drug treatment to improve physical fitness.
a, life conditioning: infection, fatigue, mental stimulation, etc. often become the cause of acute hemolysis of the disease, life conditioning is essential, to live regularly, with the changes in climate, timely increase or decrease clothes, avoid external feelings.
b, diet conditioning: the pathogenesis of this disease is a virtual inclusion, the disease is mostly qi and blood loss, the kidney is spleen and kidney, the plain is mainly based on virtual or virtual, taboo cold fruit to avoid damage to the spleen and stomach, spicy nourishing The product should also avoid or eat less, always take care of the spleen and stomach.
c, mental conditioning: correct treatment of diseases, avoid heavy physical labor, avoid mental stress, flirt, do not be excited, can exercise properly to enhance physical fitness, but those who suffer from qi and blood deficiency should not practice qigong, so as to avoid qi and blood consumption, increase blood Virtual.
Complication
Autoimmune hemolytic anemia complications Complications anemia jaundice
Individual combined with immune thrombocytopenia accompanied by bleeding symptoms, caused by syphilis or viral infection, such as chills, high fever, anemia, jaundice, hemoglobinurie and other acute hemolysis, serious life-threatening, cold hemolytic test.
Symptom
Autoimmune hemolytic anemia symptoms Common symptoms Low back pain, immunity, decreased hemoglobin, waist, knees, acidity, dizziness, immune hemolytic qi stagnation, blood stasis, jaundice, short proteinuria
[Type]
Divided into primary AIHA and secondary AIHA In addition, AIHA is mainly classified according to the characteristics of its own erythrocyte antibody. It is currently divided into three categories, namely, warm antibody type, cold antibody type and warm cold double antibody type, each of which has Different subtypes.
[clinical manifestations]
The clinical manifestations of this disease are multi-terminal, warm antibody type AIHA is mostly chronic onset, easy to repeat, some patients have a history of acute attacks, chills, fever, jaundice, low back pain, etc., hemoglobinuria is common in paroxysmal coldness Hemoglobinuria, rare in cold agglutinin disease, warm antibody type AIHA is extremely rare; often repeated, often more illusory, the characteristics of this virtual standard, the disease is based on virtual, qi and blood loss, even The spleen and kidney are imaginary, the disease is easy to see white, shortness of breath, lazy words, dizziness, tinnitus, less stool, weak waist and knee embolism, viscera syndrome and kidney, spleen and viscera most closely related, the standard or the evil of damp heat, Or for cold evil; long-term disease into the collaterals caused by qi stagnation and blood stasis, the formation of block formation in the late stage, the early treatment of this disease should be combined with clear damp heat and tonic, there is a hemoglobinuria.
Examine
Autoimmune hemolytic anemia check
1. Blood: Hemoglobin is reduced, positive cells are pigmented anemia; white blood cells and platelets are normal; reticulocytes are increased, small spherical red blood cells are increased, and young red blood cells are seen.
2. Bone marrow: hyperplasia, with obvious proliferation of young red blood cells, normal granulocyte and megakaryocyte cell lines.
3. Blood indirect erythropoietin increased, serum haptoglobin decreased or disappeared, plasma free hemoglobin increased, and urine hemosiderin was negative.
4. Direct anti-human globulin test positive, indirect anti-human globulin test positive or negative (warm antibody type autoimmune hemolytic anemia).
5. Positive cold agglutination test (cold agglutinin syndrome).
6. The hot and cold hemolysis test is positive, and the urine hemosiderin test is positive (paroxysmal cold hemoglobinuria).
Diagnosis
Diagnosis and diagnosis of autoimmune hemolytic anemia
Diagnostic criteria
The general examination of the AIHA is mainly used to determine whether the subject is anaemic, hemolyzed, with or without autoimmunity or other primary disease.
1, blood: anemia or accompanied by platelets, white blood cell count decreased, reticulocyte count increased (significant reduction in the risk of aplastic anemia).
2, bone marrow: more proliferative anemia (red is mainly red and medium red) bone marrow; aplastic anemia can be aplastic anemia bone marrow changes.
3. Plasma or serum: hyperhemoglobin and/or hyperbilirubinemia.
4, urine: high urinary biliary or high free HB or high hemosiderin.
5, immune indicators: the amount of gamma globulin can be increased, C3 levels can be reduced, anti-O, erythrocyte sedimentation rate, rheumatoid factor, anti-nuclear antibodies, anti-DNA antibodies and other indicators of abnormalities.
6, other: including cardiopulmonary liver and kidney function tests, different primary diseases may have different performance in different organs.
Differential diagnosis
1. Hereditary spherocytosis: a family history; peripheral blood small spherical red blood cells > 10%; red blood cell osmotic fragility test positive; autolysis test: hemolysis > 5%.
2. Paroxysmal nocturnal hemoglobinuria: acid hemolysis test, positive venom factor hemolysis test, urine hemosiderin test positive.
3. Glucose-6-phosphate dehydrogenase deficiency: methemoglobin reduction test positive; fluorescent spot test, nitrotetrazolium basket paper method: G6PD activity decreased.
