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If you live with warm autoimmune hemolytic anemia (AIHA), it means your red blood cells have a shorter lifespan than they typically would. This can lead to symptoms that complicate everyday life, so you may need treatment to manage those symptoms and prevent complications.
Overall, autoimmune hemolytic anemia is considered a rare disease. Warm AIHA is the most common type, accounting for between 60 percent and 70 percent of autoimmune hemolytic anemia cases.
Being diagnosed with an autoimmune disease like warm AIHA can be a big life adjustment, but learning about your condition can help you navigate any challenges that may come with your diagnosis. We’ll cover warm AIHA symptoms, treatments, and what makes it different from other types of autoimmune hemolytic anemia to give you a starting point.
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Warm AIHA is an autoimmune disorder, which means it occurs when your immune system turns on your own healthy tissues and attacks them as if they were invaders from outside your body. This can happen at any age, but the most common age range for the onset of warm AIHA is between 50 and 70 years of age.
In any type of autoimmune hemolytic anemia, the immune system attacks healthy red blood cells (RBCs). In warm AIHA, it does this by producing proteins called antibodies that flag red blood cells for destruction, mainly in the spleen. When the immune system makes antibodies against your own tissues like this, they’re called autoantibodies.
Typically, red blood cells have a lifespan of about 120 days. At the end of that lifespan, the spleen destroys them.
Your bone marrow continuously produces new red blood cells to replace those that are lost. If you have warm AIHA, red blood cell production may not keep up with the rate of loss.
What makes warm AIHA different from other types of AIHA is that the autoantibodies are active at your normal body temperature. This isn’t true of every type of AIHA.
Primary, or idiopathic, warm AIHA means there isn’t a clear cause for red blood cells being tagged for destruction so early in their lifespan. It seems to happen spontaneously and not because of any other disease or condition.
If you have secondary warm AIHA, another condition or trigger has altered the immune system to cause the early destruction of red blood cells. Possible causes and triggers of secondary warm AIHA include:
The symptoms of warm AIHA can vary from person to person and can start either suddenly or gradually. Sometimes when warm AIHA develops gradually, there are no noticeable symptoms.
Most commonly, people with warm AIHA first mention symptoms of anemia to their doctors. Anemia means you don’t have enough healthy red blood cells or hemoglobin to carry oxygen throughout your body. Hemoglobin is a protein in red blood cells that carries oxygen.
Anemia can cause the following symptoms:
When RBCs are destroyed in warm AIHA, they can release extra hemoglobin into the blood and urine. This can cause your urine to be darker than usual.
This extra hemoglobin can also break down into a substance called bilirubin. Too much bilirubin in your system can cause jaundice, which is the yellowing of your skin and the whites of your eyes.
You should seek urgent care if you notice any signs that red blood cells are breaking down very quickly in large amounts. Get medical help right away if you experience:
Warm AIHA can put you at risk of complications beyond the anemia itself. You may be more likely to develop blood clots with warm AIHA, which often start in the legs. Blood clots can detach from their starting point and travel to other parts of your body, putting you at risk for major medical emergencies like pulmonary embolism (a blood clot in the lungs).
Blood clots are more common in people with severe hemolysis (red blood cell breakdown) and those who have had a splenectomy (removal of the spleen). People treated with splenectomy may also be at an increased risk of infections.
Treatment options for warm AIHA aim to reduce symptoms, often by improving red blood cell count or reducing immune system activity.
Corticosteroids are the main first-line treatment for warm AIHA. They work by decreasing the production of autoantibodies within the immune system so that fewer red blood cells are flagged for destruction.
Between 20 percent and 30 percent of people who take corticosteroids for warm AIHA achieve lasting remission after initial treatment with steroids, meaning the disease stays under control. However, long-term steroid treatment can be risky, and symptoms can return as your dose is lowered or after you stop taking them. You might need other treatments if steroids aren’t effective or if your symptoms return.
Rituximab is a second-line treatment for warm AIHA, often prescribed for severe or relapsed warm AIHA, or warm AIHA that doesn’t respond to corticosteroids. It’s a monoclonal antibody (a lab-made immune protein) that can help reduce the production of autoantibodies. Sometimes, doctors prescribe rituximab alongside corticosteroids for warm AIHA.
Immunosuppressants are drugs that reduce immune system activity, which can be helpful for people with autoimmune diseases. Immunosuppressants may be recommended as a third-line treatment for warm AIHA, sometimes alongside corticosteroids.
Splenectomy is a surgery that removes your spleen, which may become enlarged if you have warm AIHA. An enlarged spleen can cause bloating or a feeling of fullness in your belly. Splenectomy is usually only recommended in severe cases of warm AIHA.
Researchers are studying new treatments for warm AIHA to expand the available options. One recently approved treatment is nipocalimab-aahu (Imaavy), which the U.S. Food and Drug Administration (FDA) approved for people ages 12 and older who are currently or were previously treated with corticosteroids. Imaavy is a monoclonal antibody that blocks a protein called the neonatal Fc receptor (FcRn).
FcRn inhibitors may quickly lower autoantibody levels by helping autoantibodies break down inside your cells. This leaves fewer autoantibodies in your bloodstream to flag red blood cells for destruction.
You might receive supportive care for warm AIHA alongside medications you’ve been prescribed. Folic acid supplements are routinely recommended because developing red blood cells need folate to mature. You might need a blood transfusion to receive more healthy RBCs and treat your anemia.
Your prognosis with warm AIHA depends on many factors, including your age and the underlying cause if you have secondary warm AIHA. Fortunately, treatment can help, and many people are able to go into remission with the right care. Talk to your doctor about treatment options that can give you the best possible prognosis.
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