$Unique_ID{BRK03462} $Pretitle{} $Title{Anemia, Hemolytic, Warm Antibody} $Subject{Anemia Hemolytic Warm Antibody Autoimmune Hemolytic Anemia Warm Reacting Antibody Disease Paroxysmal Cold Hemoglobinuria Cold Antibody Hemolytic Anemia Chronic Lymphatic Leukemia Lymphoma Lupus Erythematosus } $Volume{} $Log{} Copyright (C) 1990 National Organization for Rare Disorders, Inc. 770: Anemia, Hemolytic, Warm Antibody ** IMPORTANT ** It is possible that the main title of the article (Warm Antibody Hemolytic Anemia) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Autoimmune Hemolytic Anemia Warm Reacting Antibody Disease Information on the following diseases can be found in the Related Disorders section of this report: Paroxysmal Cold Hemoglobinuria Cold Antibody Hemolytic Anemia Chronic Lymphatic Leukemia Lymphoma Lupus Erythematosus General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Warm Antibody Hemolytic Anemia is an autoimmune disorder characterized by the premature destruction of red blood cells by the body's natural defenses against invading organisms (antibodies). Normally, the red blood cells have a life span of approximately 120 days before they are removed by the spleen. In an individual affected with Warm Antibody Hemolytic Anemia, the red blood cells are destroyed prematurely and bone marrow production of new cells can no longer compensate for their loss. The severity of the anemia is determined by the time the red blood cells are allowed to survive and by the capacity of the bone marrow to continue new red blood cell production. Immune Hemolytic Anemias are subdivided by the optimal temperature at which the antibodies destroy red blood cells. As their names imply, Warm Antibody Hemolytic Anemia occurs at temperatures of 37 degrees Centigrade or higher while Cold Antibody Hemolytic Anemia occurs usually at lower temperatures of. (For more information on this disorder, choose " Cold Antibody Hemolytic Anemia" as your search term in the Rare Disease Database.) Symptoms The severity of symptoms of Warm Antibody Hemolytic Anemia is determined by the rate of onset, the rate of destruction of healthy red blood cells and the presence of an underlying disorder. Symptoms will vary from person to person. If the anemia has a sudden onset, the affected individual will usually experience pallor, fatigue, difficulty breathing upon exertion, dizziness and palpitations. When the onset is more gradual the anemia is usually less severe, and the patient may show no symptoms. Yellowing of the skin (jaundice) and enlargement of the spleen are commonly present. Causes In an individual affected with Warm Antibody Hemolytic Anemia, certain cells (antibodies) which normally attack bacteria mistakenly attack and destroy healthy red blood cells. Approximately 25% of reported cases of this disorder occur for unknown reasons while an estimated 65% are the result of some underlying disorder such as Chronic Lymphocytic Leukemia or other diseases of the lymph system. Systemic Lupus Erythematosus, Rheumatoid Arthritis and Ulcerative Colitis are all associated with Warm Antibody Hemolytic Anemia. Another 10% to 15% of cases are believed to result from a reaction to certain medications such as methyldopa. Affected Population Anyone may develop Warm Antibody Hemolytic Anemia. Individuals with certain diseases which produce abnormalities of the immune system are at higher risk. Related Disorders Symptoms of the following disorders can be similar to those of Warm Antibody Hemolytic Anemia. Comparisons may be useful for a differential diagnosis: Paroxysmal Cold Hemoglobinuria (PCH) is an extremely rare autoimmune hemolytic disorder characterized by a disintegration of red blood cells (hemolysis) occurring minutes to hours after exposure to cold. Symptoms include severe pain in the back and legs, headache, vomiting, diarrhea and passage of blood in the urine (hemoglobinuria). There may be temporary enlargement of the liver and spleen. This disorder is most frequently associated with viral infections such as chickenpox and mumps. (For more information on this disorder, choose "Paroxysmal Cold Hemoglobinuria " as your search term in the Rare Disease Database.) Cold Antibody Hemolytic Anemia is a rare autoimmune hemolytic disorder in which red blood cells are attacked and destroyed by the body's natural defenses (antibodies) particularly at lower than normal temperatures. Symptoms may include weakness, dizziness, headache, ringing in the ears (tinnitus), spots before the eyes, fatigue, drowsiness, irritability and bizarre behavior. Absent menstruation, gastrointestinal complaints, yellowing of the skin (jaundice) and enlargement of the spleen may also occur along with the passage of dark urine (hemoglobinuria). (For more information on this disorder, choose "Paroxysmal Cold Hemoglobinuria" as your search term in the Rare Disease Database.) The following disorders may precede the development of Warm Antibody Hemolytic Anemia. They can be useful in identifying an underlying cause of some forms of this disorder: Chronic Lymphatic Leukemia is a disorder characterized by an excessive amount of white blood cells in the bone marrow, spleen, liver and blood. As the disease progresses, the leukemic cells invade other areas of the body including the intestinal tract, kidneys, lungs, gonads and lymph nodes. Symptoms of Chronic Lymphatic Leukemia may include fatigue, weakness, itchiness, night sweats, abdominal discomfort or weight loss. An enlarged spleen is usually discovered upon physical examination. Lymphoma is a malignant growth which most commonly occurs in the lymph nodes, spleen and other areas involved in the body's immune system (lymphoreticularsystem). The major types of this disorder are Hodgkin's Disease and Non-Hodgkin's Lymphoma. (For more information on this disorder, choose "Hodgkin's Disease" as your search term in the Rare Disease Database.) Lupus Erythematosus is an inflammatory connective tissue disease that can affect many parts of the body including the joints, skin and internal organs. Lupus is a disease of the body's immune system, most often striking young women between the ages of 15 and 35 years. The symptom for which Lupus was originally named, a butterfly-shaped red rash across the bridge of the nose and cheeks, is found in only five percent of newly diagnosed patients. Arthritic symptoms such as painfully inflamed joints are much more common. (For more information on this disorder, choose "Lupus" as your search term in the Rare Disease Database.) Therapies: Standard Warm Antibody Hemolytic Anemia is usually treated with corticosteroid drugs and can usually be well controlled with proper treatment. For the small number of cases which do not respond to corticosteroid therapy, immunosuppressive drugs may be administered. Severe cases may require removal of the spleen. In affected individuals with an underlying disorder, treatment of the disorder usually brings marked improvement of the anemia. If the anemia is the result of medication, symptoms will usually subside upon discontinuance of the medication under a physician's supervision. Studies are being conducted in the use of Sandoglobulin as a treatment for Warm Antibody Hemolytic Anemia. Further investigation is needed to determine it's safety and effectiveness. Therapies: Investigational This disease entry is based upon medical information available through July 1990. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Warm Antibody Hemolytic Anemia, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Heart, Blood and Lung Institute 9000 Rockville Pike Bethesda, MD 20892 (301) 496-4236 References INCOMPLETE WARM HEMOLYSINS. II. CORRESPONDING ANTIGENS AND PATHOGENIC MECHANISMS IN AUTOIMMUNE HEMOLYTIC ANEMIAS INDUCED BY INCOMPLETE WARM HEMOLYSINS. M.W. Wolf et al.; CLIN IMMUNOPATHOL (April, 1989; issue 51 (1)). Pp. 68-76. PRODUCTION OF HUMAN WARM-REACTING RED CELL MONOCLONAL AUTOANTIBODIES BY EPSTEIN-BARR VIRUS TRANSFORMATION. C. Andrzejewski et al.; TRANSFUSION (March-April, 1989: issue 29 (3)). Pp. 196-200. CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, M.D. et al., eds; W.B. Saunders Company, 1988. Pp. 917-920. INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 1057-1059. THE MERCK MANUAL, Volume 1, 14th Ed.: Robert Berkow, M.D., ed.-in-chief; Merck Sharp & Dohme Laboratories, 1982. Pp. 1115.