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Information for patients and families
Autoimmune refers to when the body’s immune system mistakenly attacks and destroys healthy cells; hemolytic refers to the destruction of red blood cells; and anemia refers to when the blood does not contain enough healthy red blood cells.
It is the most common autoimmune hemolytic anemia and can occur at any age.
In CAD, hemolysis occurs more frequently at cold temperatures, hence the name “cold,” usually between 37 to 39oF, or 3 to 4oC.
Conversely, CAD is less common and generally occurs between 40 to 80 years of age.
The symptoms of both WAHA and CAD vary depending on severity.
Individuals with WAHA may also develop an enlarged spleen, causing a full feeling in the abdomen.
Individuals may also develop blood clots that can form in the legs, called deep vein thrombosis, and cause symptoms such as pain, swelling, redness, and warmth in one leg.
Individuals with CAD may also experience circulatory symptoms such as cold fingers and toes, and painful bluish or reddish discoloration of the fingers, toes, ankles, and wrists, also called Raynaud phenomenon.
Warm autoimmune hemolytic anemia, or WAHA, and cold agglutinin disease, or CAD, are autoimmune hemolytic anemias characterized by the production of autoantibodies that cause early destruction of healthy red blood cells.
In WAHA, hemolysis occurs at the body temperature, whereas CAD is triggered by cold temperatures. Symptoms vary based on severity and include dizziness, palpitations, dark urine, pale skin, jaundice, and fatigue. Individuals with WAHA may also develop an enlarged spleen or deep vein thrombosis whereas individuals with CAD may experience the Raynaud phenomenon (a condition in which small blood vessels in the fingers and toes constrict).
Diagnosis involves a thorough clinical examination, including blood and specialized testing to identify the presence of anemia resulting from hemolysis. The Coombs test confirms the presence of autoantibodies associated with WAHA or CAD. Treatment is supportive and varies based on symptoms, and may include prednisone and other immunosuppressive or chemotherapy agents, and blood transfusions in severe cases.
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