WAIHA
Terms
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- What are 3 main categories of immune hemolytic anemias?
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1. Alloantibody-induced
2. Autoantibody-induced
3. Drug-induced - What are the 2 types of alloantibody-induced HA?
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1. Transfusion reaction
2. HDN - What are the 3 types of Autoantibody-induced HA?
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1. Warm AIHA
2. Cold agglutinin disease
3. Paroxysmal Cold Hgburia - What is the cause of most cases of WAIHA?
- Idiopathic
- What are some known causes of WAIHA?
- Lymphoma, SLE, carcinoma.
- What class of antibody causes WAIHA?
- IgG
- What are some common signs and symptoms of WAIHA?
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Weak, dizzy, fever,
Spleno/hepatomegaly, lymphadenopathy. - What test is used for diagnosing autoimmune hemolytic anemias?
- DAT
- What are DAT results for WAIHA?
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Polyspecific: 3-4+
Monospecific: 3-4+
Anti-C3: 0-3+
Control: 0 - How do DAT results for WAIHA differ from CAD and PCH?
- Those both show only complement components; WAIHA rarely is complement alone.
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What needs to be determined when a patient has a positive DAT?
How is this done? - Rule out allo-antibody by doing an adsorption.
- How do you decide what type of adsorption to perform?
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-If not transfused in past 3-4 months, autoadsorption.
-If transfused, alloadsorption. - What is the principle of an autoadsorption?
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-Patient RBCs + Patient serum to remove autoantibody.
-Test for alloantibody in the serum. - How do you determine how many adsorptions to do in order to test for an underlying allo- antibody?
- Perform DAT, observe the serum reactivity; E.g., if IAT is 3+, then add 1 = 4 adsorptions.
- How do you get Patient RBCs to be free of autoab in order to remove the Auto-Ab from serum?
- By using ZZAP or enzymes to strip it from the antigens.
- When is an allogeneic adsorption performed?
- When the patient's phenotype is unknown.
- What is the treatment for WAIHA?
- Steroids - immunosuppressants