Autoimmune hemolytic anemia natural history, complications and prognosis: Difference between revisions
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==Complications== | ==Complications== | ||
* Infection is a serious concern in patients on long-term immunosuppressant therapy, especially in very young children (less than two years).<ref>{{cite journal |author=Zecca M, Nobili B, Ramenghi U, ''et al.'' |title=Rituximab for the treatment of refractory autoimmune hemolytic anemia in children |journal=Blood |volume=101 |issue=10 |pages=3857–61 |year=2003 |month=May |pmid=12531800 |doi=10.1182/blood-2002-11-3547 |url=http://www.bloodjournal.org/cgi/pmidlookup?view=long&pmid=12531800}}</ref> | Complications of autoimmune hemolytic anemia include | ||
* | *Infection is a serious concern in patients on long-term immunosuppressant therapy, especially in very young children (less than two years).<ref>{{cite journal |author=Zecca M, Nobili B, Ramenghi U, ''et al.'' |title=Rituximab for the treatment of refractory autoimmune hemolytic anemia in children |journal=Blood |volume=101 |issue=10 |pages=3857–61 |year=2003 |month=May |pmid=12531800 |doi=10.1182/blood-2002-11-3547 |url=http://www.bloodjournal.org/cgi/pmidlookup?view=long&pmid=12531800}}</ref> | ||
**'''Iron overload''': Autoimmune hemolytic anemia is frequently complicated by iron overload due to frequent [[red blood cell]] transfusions. | |||
*'''End-organ damage from impaired oxygen delivery''': The effects of severe anemia affect a variety of organs and tissues that rely heavily upon oxygen for energy metabolism. If hemoglobin decreases significantly, typically to values lower than 7g/dl, patients can experience impaired oxygen delivery and end-organ hypoxia. If hemoglobin decreases significantly, typically to values lower than 7g/dl, patients can experience impaired oxygen delivery and end-organ hypoxia. | |||
**'''Hypoxic brain injury''': This is a rare but important complication of severe anemia. Low oxygen delivery to the brain as a result of autoimmune hemolytic anemia can result in ischemic injury to neurons and supporting tissue. This is functionally similar to [[cerebrovascular accident]], or [[stroke]], which is due to atherosclerotic or embolic blockage of the cerebral circulation. Patients can experience severe symptoms such as numbness, weakness, paralysis, and [[dysarthria]], or slurred speech. Patients can have significant neurological impairment (including deficits in motor, sensory, cortical, and cerebellar function). Overall, the likelihood of hypoxic brain injury due to autoimmune hemolytic anemia is very low. | |||
**'''Myocardial injury''': Autoimmune hemolytic anemia can result in impaired oxygen delivery to the cardiac tissue. [[Myocardial infarction]] can result from poor oxygen content in the coronary circulation, which is functionally similar to having ischemia due to blockage by an atherosclerotic plaque. Patients can experience severe symptoms such as shortness of breath, fatigue, and decreased exercise tolerance. Anemia is associated with poor outcomes.<ref name="pmid26517509">{{cite journal| author=Park S, Jung CW, Kim K, Kim SJ, Kim WS, Jang JH| title=Iron deficient erythropoiesis might play key role in development of anemia in cancer patients. | journal=Oncotarget | year= 2015 | volume= 6 | issue= 40 | pages= 42803-12 | pmid=26517509 | doi=10.18632/oncotarget.5658 | pmc=4767472 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26517509 }} </ref> Patients can have long-term complications such as congestive heart failure. | |||
**'''[[High-output cardiac failure]]''': Hemolytic anemia can also be associated with high-output cardiac failure, in which the [[ejection fraction]] and [[cardiac output]] are higher than normal. This is a manifestation of impaired oxygen delivery at the tissue level, for which the body compensated by increasing the circulatory output in an attempt to deliver more oxygen to tissues. | |||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
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Overview
Natural History
Complications
Complications of autoimmune hemolytic anemia include
- Infection is a serious concern in patients on long-term immunosuppressant therapy, especially in very young children (less than two years).[1]
- Iron overload: Autoimmune hemolytic anemia is frequently complicated by iron overload due to frequent red blood cell transfusions.
- End-organ damage from impaired oxygen delivery: The effects of severe anemia affect a variety of organs and tissues that rely heavily upon oxygen for energy metabolism. If hemoglobin decreases significantly, typically to values lower than 7g/dl, patients can experience impaired oxygen delivery and end-organ hypoxia. If hemoglobin decreases significantly, typically to values lower than 7g/dl, patients can experience impaired oxygen delivery and end-organ hypoxia.
- Hypoxic brain injury: This is a rare but important complication of severe anemia. Low oxygen delivery to the brain as a result of autoimmune hemolytic anemia can result in ischemic injury to neurons and supporting tissue. This is functionally similar to cerebrovascular accident, or stroke, which is due to atherosclerotic or embolic blockage of the cerebral circulation. Patients can experience severe symptoms such as numbness, weakness, paralysis, and dysarthria, or slurred speech. Patients can have significant neurological impairment (including deficits in motor, sensory, cortical, and cerebellar function). Overall, the likelihood of hypoxic brain injury due to autoimmune hemolytic anemia is very low.
- Myocardial injury: Autoimmune hemolytic anemia can result in impaired oxygen delivery to the cardiac tissue. Myocardial infarction can result from poor oxygen content in the coronary circulation, which is functionally similar to having ischemia due to blockage by an atherosclerotic plaque. Patients can experience severe symptoms such as shortness of breath, fatigue, and decreased exercise tolerance. Anemia is associated with poor outcomes.[2] Patients can have long-term complications such as congestive heart failure.
- High-output cardiac failure: Hemolytic anemia can also be associated with high-output cardiac failure, in which the ejection fraction and cardiac output are higher than normal. This is a manifestation of impaired oxygen delivery at the tissue level, for which the body compensated by increasing the circulatory output in an attempt to deliver more oxygen to tissues.
Prognosis
References
- ↑ Zecca M, Nobili B, Ramenghi U; et al. (2003). "Rituximab for the treatment of refractory autoimmune hemolytic anemia in children". Blood. 101 (10): 3857–61. doi:10.1182/blood-2002-11-3547. PMID 12531800. Unknown parameter
|month=ignored (help) - ↑ Park S, Jung CW, Kim K, Kim SJ, Kim WS, Jang JH (2015). "Iron deficient erythropoiesis might play key role in development of anemia in cancer patients". Oncotarget. 6 (40): 42803–12. doi:10.18632/oncotarget.5658. PMC 4767472. PMID 26517509.