Immune Hemolytic Anemias

Author: Erin Tretter, MBA, MT(ASCP)
Reviewer: Kathy W. Jones, MS, MLS(ASCP)CM and Laurie Bjerklie, MA, MLS(ASCP)CM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Blood Banking / Immunohematology): 1 hour(s)

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The serologic findings in the blood bank help to determine if the hemolysis is immune-mediated and what type of immune hemolytic anemia may be present. This course compares the different types of immune hemolytic anemias. Mechanisms and medications involved in drug-induced hemolytic anemias are discussed as well.

Objectives

  • Compare the different types of immune hemolytic anemias.
  • Identify and investigate potential serologic discrepancies caused by autoimmune and drug-induced hemolytic anemias.
  • Differentiate the four mechanisms involved in drug-induced hemolytic anemias.
  • List medications that may be associated with drug-induced hemolytic anemia.

Course Outline

  • Immune Hemolytic Anemias
    • Introduction
    • Direct Antiglobulin Test (DAT)
    • Classification of Hemolytic Anemias
  • Alloimmune Hemolytic Anemia
    • Alloimmune Hemolytic Anemia
  • Autoimmune Hemolytic Anemia
    • Autoimmune Hemolytic Anemia (AIHA) Introduction
    • Symptoms of Autoimmune Hemolytic Anemia
    • Testing for Autoantibodies
    • Possible Serological and Laboratory Presentations
    • True or False: A direct antiglobulin test (DAT) is usually negative in cases of autoimmune hemolytic anemia.
    • Symptoms associated with autoimmune hemolytic anemias can include:
  • Cold Autoimmune Hemolytic Anemia
    • Cold Autoimmune Hemolytic Anemia
    • Cold Hemagglutinin Disease (CHD)
    • Paroxysmal Cold Hemoglobinuria (PCH)
    • Donath-Landsteiner Test
    • ABO/Rh Typing in the Presence of Cold Autoantibodies
    • Laboratory Presentations of Cold Autoantibodies
    • True or False: In paroxysmal cold hemoglobinuria (PCH), the autoantibody specificity is most commonly anti-I.
    • True or False: Cold hemagglutinin disease (CHD) is caused by an IgM antibody with a broad thermal range.
  • Warm Autoimmune Hemolytic Anemia
    • Warm Autoimmune Hemolytic Anemia (WAIHA)
    • Serological Characteristics in WAIHA
    • WAIHA Investigation: Serological Findings Following Elution
    • Possible Scenarios When Transfusions are Needed in the Presence of WAIHA
    • Detection and Identification of an Alloantibody in the Presence of a Warm-Reactive Autoantibody
    • Autologous Adsorption (Autoadsorption)
    • Allogeneic Adsorption
    • Transfusion Considerations for WAIHA
    • Treatment of WAIHA
    • True or False: In a case of WAIHA, the production of IgG or IgG and complement that sensitizes the red blood cells leads to red blood cell destruction.
    • Which type of adsorption must be done if a patient has been recently transfused?
  • Mixed-Type Autoimmune Hemolytic Anemia
    • Mixed-Type Autoimmune Hemolytic Anemia (AIHA)
  • Drug-Induced Hemolytic Anemia
    • Drug-Induced Immune Hemolytic Anemia Introduction
    • Mechanisms
    • Drug Adsorption Mechanism
    • Immune Complex Mechanism
    • Membrane Modification (Non-Immune Adsorption of Proteins)
    • Induction of Autoimmunity
    • Treatment of Drug-Induced Immune Hemolytic Anemia
    • Laboratory Investigation of Drug-Induced Immune Hemolytic Anemia
    • Which mechanism of drug-induced red cell destruction closely mimics the serologic presentation of warm autoimmune hemolytic anemia (WAIHA)?
    • Which mechanism of drug-induced hemolytic anemia involves the formation of drug-antibody combinations that bind non-specifically to RBC membranes and activate complement?
    • True or False: Penicillin is one of the medications that may be responsible for the immune complex mechanism of drug-induced hemolytic anemia.
  • Case Study One
    • Case Study OneA 50-year-old patient with systemic lupus erythematosus (SLE) is admitted to the hospital with evidence of hemolysis, including decreased hemoglobin and hematocrit, increased reticulocyte count, and increased indirect bilirubin. The patient has no recent history of transfusion. An antibody screen is ordered and 3+ agglutination is observed at the AHG phase for all cells. An autologou
    • Case Study One, continued
    • Case Study One, continued
    • Case Study One, continued
    • Case Study OneTo determine the appropriate adsorption technique to use, an accurate transfusion history must be obtained. In this case, the patient has not been recently transfused (i.e., not transfused within the past three months). Which adsorption technique is normally utilized if the patient has not been recently transfused?
    • Case Study OneThe results of the autoadsorbed serum tested with a set of antibody screen cells are shown on the right. What does the pattern of reactivity indicate?
    • Case Study One Conclusion
  • Case Study Two
    • Case Study Two
    • Case Study Two, continued
    • Case Study TwoA DAT is ordered on the patient along with an antibody screen. The DAT is positive and the antibody screen is negative. Elution studies are then performed. An elution is a technique where the antibody is dissociated from sensitized red blood cells and harvested. One method that is commonly used is an acid elution. In this method, an acidic solution is added to a volume of red blood c
    • Case Study Two Conclusion
  • References
    • References

Additional Information

Level of instruction: Intermediate 
Intended audience: Medical laboratory scientists, technicians, and pathologists. This course is also appropriate for medical laboratory science students and pathology residents.
Author information: Erin Tretter, MBA, MT(ASCP), is currently the Rapid Response Laboratory Supervisor at Paoli Hospital. Erin received her Master in Business Administration from the Florida Institute of Technology where she is a member of the Phi Kappa Phi Honor Society. She received her BS in Medical Technology from the California University of Pennsylvania and has experience as a Generalist, including Blood Bank, Hematology, and Chemistry. Erin is currently the Blood Bank Clinical Instructor for the Clinical Laboratory Science Program at St. Christopher’s Hospital for Children and has 7 years of experience teaching immunohematology concepts and laboratory procedures to laboratory science students. She has also taught Blood Bank in the Clinical Laboratory Technician program at the Community College of Philadelphia.
Reviewer information: 
Kathy W. Jones, MS, MLS(ASCP)CM is currently an Associate Professor in the Medical Laboratory Science Program at Auburn University Montgomery where she is responsible for the program courses in Clinical Hematology and Clinical Immunology. She holds a BS degree in Biology as well as a Master’s degree in Adult Education from Troy University. She received her Medical Laboratory Science certificate from St. Margaret’s Hospital School of Medical Technology and has over 40 years of experience in laboratory science. Before she became a full-time educator, she served in various roles in the clinical laboratory which included five years as a Hematology Supervisor.
Laurie Bjerklie, MA, MLS(ASCP)CM is currently a Content Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.