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Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review

Until now, treatment of primary autoimmune hemolytic anemia of the warm type (wAIHA) is primarily based on immunosuppression. However, many patients do not respond adequately to treatment, and treated patients may develop severe side effects due to uncontrolled, mixed and/or long-lasting immunosuppr...

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Autor principal: Salama, Abdulgabar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678315/
https://www.ncbi.nlm.nih.gov/pubmed/26696797
http://dx.doi.org/10.1159/000438731
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author Salama, Abdulgabar
author_facet Salama, Abdulgabar
author_sort Salama, Abdulgabar
collection PubMed
description Until now, treatment of primary autoimmune hemolytic anemia of the warm type (wAIHA) is primarily based on immunosuppression. However, many patients do not respond adequately to treatment, and treated patients may develop severe side effects due to uncontrolled, mixed and/or long-lasting immunosuppression. Unfortunately, the newly used therapeutic monoclonal antibodies are unspecific and remain frequently ineffective. Thus, development of a specific therapy for AIHA is necessary. The ideal therapy would be the identification and elimination of the causative origin of autoimmunization and/or the correction or reprogramming of the dysregulated immune components. Blood transfusion is the most rapidly effective measure for patients who develop or may develop hypoxic anemia. Although some effort has been made to guide physicians on how to adequately treat patients with AIHA, a number of individual aspects should be considered prior to treatment. Based on my serological and clinical experience and the analysis of evidence-based studies, we remain far from any optimized therapeutic measures for all AIHA patients. Today, the old standard therapy using controlled steroid administration, with or without azathioprine or cyclophosphamide, is, when complemented with erythropoiesis-stimulating agents, still the most effective therapy in wAIHA. Rituximab or other monoclonal antibodies may be used instead of splenectomy in therapy-refractory patients.
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spelling pubmed-46783152015-12-22 Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review Salama, Abdulgabar Transfus Med Hemother Review Article Until now, treatment of primary autoimmune hemolytic anemia of the warm type (wAIHA) is primarily based on immunosuppression. However, many patients do not respond adequately to treatment, and treated patients may develop severe side effects due to uncontrolled, mixed and/or long-lasting immunosuppression. Unfortunately, the newly used therapeutic monoclonal antibodies are unspecific and remain frequently ineffective. Thus, development of a specific therapy for AIHA is necessary. The ideal therapy would be the identification and elimination of the causative origin of autoimmunization and/or the correction or reprogramming of the dysregulated immune components. Blood transfusion is the most rapidly effective measure for patients who develop or may develop hypoxic anemia. Although some effort has been made to guide physicians on how to adequately treat patients with AIHA, a number of individual aspects should be considered prior to treatment. Based on my serological and clinical experience and the analysis of evidence-based studies, we remain far from any optimized therapeutic measures for all AIHA patients. Today, the old standard therapy using controlled steroid administration, with or without azathioprine or cyclophosphamide, is, when complemented with erythropoiesis-stimulating agents, still the most effective therapy in wAIHA. Rituximab or other monoclonal antibodies may be used instead of splenectomy in therapy-refractory patients. S. Karger AG 2015-09 2015-08-10 /pmc/articles/PMC4678315/ /pubmed/26696797 http://dx.doi.org/10.1159/000438731 Text en Copyright © 2015 by S. Karger GmbH, Freiburg http://www.karger.com/Authors_Choice This is an open access article distributed under the terms of Karger's Author's Choice™ licensing agreement, adapted from the Creative Commons Attribution Non-Commercial 2.5 license. This license allows authors to re-use their articles for educational and research purposes as long as the author and the journal are fully acknowledged.
spellingShingle Review Article
Salama, Abdulgabar
Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title_full Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title_fullStr Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title_full_unstemmed Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title_short Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review
title_sort treatment options for primary autoimmune hemolytic anemia: a short comprehensive review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678315/
https://www.ncbi.nlm.nih.gov/pubmed/26696797
http://dx.doi.org/10.1159/000438731
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