?autoimmune hemolytic anemia

April 20, 2009 at 10:43 pm

People with one autoimmune process–like CIDP–are also at a slightly greater risk of other autoimmune processes. One of the other autoimmune problems that also does better with steroids or immunoglobulin is autoimmune hemolytic anemia. This is where antibody attachs the red blood cells and causes them to break apart (often when the RBCs pass through the spleen). It sounds like you stay anemic since hemoglobins of 9.2 or 10.4 are low. One way to check about autoimmune hemolytic anemia (AIHA) is to check a reticulocyte count when a blood test is done for hemoglobin. Reticulocytes are the young red blood cells. If a person has a hemolytic anemia, the reticulocyte count will be higher because the body is trying to make more blood in order to keep up with the destruction–that is, the body is trying hard to compensate for the autoimmune process. A direct Coomb’s test will show if there is antibody on the red blood cells, but this test should be done as long after administration of immunoglobulin as possible to reduce the small chance of a false positive.

Another possible cause for anemia that responds to immunoglobulin or steroids is a vasculitis (such as from lupus/SLE) in which inflammation in the blood vessels causes blood to break apart. This is a different autoimmune problem.

Having a hemoglobin as low as yours is would make you more tired. If fatigue is a big issue with you, it might well be worth seeing a hematologist to see if the cause of the anemia could be found and corrected so that you would have more energy. A deficiency in B12 can cause anemia and a neuropathy like CIDP or make the neuropathy of CIDP worse. People with B12 deficiency typically have red blood cells that are larger than usual (MCV is higher than normal). It is definitely worth treating B12 deficiency if that were a problem.