Introduction
Autoimmune hemolytic anemia (AIHA) is a group of diseases in which the immune system attacks and kills the body's red blood cells (RBCs). Within AIHA, MAHA or mixed autoimmune hemolytic anemia stands out as a different condition because it has multiple causes, including other mechanisms and illnesses. The exact cause of mixed autoimmune hemolytic anemia is still unknown. Still, it is thought to be a combination of immune dysregulation and autoimmune diseases, infections, medications, or cancers already present. The autoantibodies, usually immunoglobulin G (IgG) or immunoglobulin M (IgM), bind to the red blood cells and destroy them in different ways, such as through complement-mediated lysis or macrophages eating them.
The rare and complicated hematological condition known as mixed autoimmune hemolytic anemia (MAHA) is characterized by the destruction of red blood cells (RBCs) because of autoantibodies in the affected individual's blood. It is a distinct subset of autoimmune hemolytic anemia that is characterized by the presence of several underlying factors that contribute to the progression of the disorder. When diagnosing, managing, and understanding the underlying mechanisms, MAHA presents a large set of obstacles.
What Is a Mixed Autoimmune Hemolytic Anemia?
In the extremely rare case of mixed autoimmune hemolytic anemia (MAHA), the immune system mistakenly targets the body's own red blood cells. Anemia, in which the body's tissues do not receive enough oxygen because there are not enough red blood cells, can result from this disorder. It is characterized by the presence of both warm and cold autoantibodies. These autoantibodies have the potential to cause damage to red blood cells at both the temperature of the body and lower temperatures.
When an individual possesses cold and warm autoantibodies, they have mixed-type autoimmune hemolytic anemia. Cold autoantibody in mixed-type AIHA has an overall thermal amplitude and is reactive at 30 degrees Celsius or above with either a high or low titer. Cold autoantibodies are IgM, while warm antibodies are IgG.
Both IgG and C3 are found in the patient's red blood cells. This frequently results in responsiveness throughout all testing phases and with all cells tested. Cold and warm auto adsorption may be required to determine the presence of alloantibodies. Cold antibodies are typically anti-I or anti-i specific. In a normal warm autoimmune hemolytic anemia, the warm antibody is serologically indistinguishable from the autoantibodies (WAIHA). If a transfusion is required, the considerations for blood selection are identical to those for congenital heart disease and warm autoimmune hemolytic anemia.
What Are the Causes of Mixed Autoimmune Hemolytic Anemia?
The causes of mixed autoimmune hemolytic anemia (AIHA) are not fully understood. Still, the condition is believed to result from a dysregulated immune response that produces autoantibodies targeting red blood cells. Several factors and underlying conditions have been associated with the development of mixed AIHA. Here are some of the potential causes:
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Autoimmune Disorders: Anemia, in which the body lacks sufficient red blood cells to carry oxygen Several other autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and autoimmune thyroiditis, have been linked to mixed AIHA. Red blood cell autoantibodies may arise as a result of immune system malfunction in various diseases.
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Infections: Certain infections have been linked to the development of AIHA, including viral infections such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), and HIV (human immunodeficiency virus). The condition may trigger an abnormal immune response, leading to the production of autoantibodies.
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Medications: Some drugs have been implicated in causing AIHA, including certain antibiotics (e.g., Penicillin, Cephalosporins), nonsteroidal anti-inflammatory drugs (NSAIDs), and antiepileptic medications. The mechanism behind drug-induced AIHA is thought to involve the production of drug-induced autoantibodies that recognize red blood cells.
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Malignancies: AIHA can occur in the context of certain malignancies, particularly lymphomas and leukemias. It is believed that the cancer cells or the body's immune response to cancer trigger the production of autoantibodies targeting red blood cells.
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Genetic Predisposition: There may be a genetic component to the development of AIHA, because people who have a history of autoimmune disease in their family are more likely to develop the condition themselves.
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It is important to note that in some cases of Mixed AIHA, no specific underlying cause has a clear root. This form of AIHA is called "primary" or "idiopathic."
What Are the Symptoms of Mixed Autoimmune Hemolytic Anemia?
The severity of mixed autoimmune hemolytic anemia determines the signs and symptoms of the disorder at any given point in time. In circumstances where it is only minor, there may be no symptoms at all. In more severe cases, symptoms may include the following:
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Fatigue.
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Weakness.
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Pale skin.
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Rapid heart rate.
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Chest pain and confusion.
How Is Mixed Autoimmune Hemolytic Anemia Diagnosed?
The evidence of hemolytic anemia, which includes anemia, jaundice, splenomegaly, reticulocytosis, elevated serum bilirubin, and a positive DAT (direct antiglobulin test), is used to diagnose autoimmune hemolytic anemia. Mixed autoimmune hemolytic anemia is a rare variant of SLE (systemic lupus erythematosus), but it is more common in children than in adults. Mixed autoimmune hemolytic anemia (MAHA) is diagnosed through a series of tests, which include:
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Complete blood count (CBC).
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Coombs Test: An antibody test that looks for antibodies in the blood that potentially harm red blood cells.
How Is Mixed Autoimmune Hemolytic Anemia Treated?
There is no one-size-fits-all approach to treatment for mixed autoimmune hemolytic anemia, as the underlying cause varies from person to person. Treatment options may include:
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Taking medication to suppress the immune system, such as corticosteroids or immunosuppressants.
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Receiving blood transfusions to replace red blood cells that have been destroyed.
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Undergoing chemotherapy to destroy abnormal white blood cells.
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Taking medication to treat an underlying infection or autoimmune condition.
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Surgery to remove the spleen, which is often enlarged in people with mixed autoimmune hemolytic anemia.
Conclusion:
Mixed autoimmune hemolytic anemia is a hematological disorder where warm and cold antibodies destroy red blood cells. The early diagnosis and appropriate treatment are very important in managing severe anemia symptoms and preventing complications. Further investigation of the fundamental mechanisms and specific treatments is imperative to enhance the outlook and well-being of those impacted by this arduous ailment.
