Production of auto antibodies against RBC antigens leads to anemic condition in some people. Hemolysis is usually extra vascular. There are two groups of antibodies responsible for hemolytic anemia they are, warm and cold antibodies.

Generally the cold auto antibodies are complete agglutinating antibodies and belong to the IgM class. They agglutinate erythrocytes at < 37°C but not at > 37° C. Cold agglutinins are seen in paroxysmal cold hemoglobulinuria, trypanosomiasis, black water fever and primary atypical pneumonia.

Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia (AIHA); it is more common among women. Warm antibodies are frequently seen in patients taking drugs like sulphonamides, antibiotics, and alpha methyl dopa.

Auto antibodies in warm antibody hemolytic anemia generally react at temperatures > 37° C. They may arise spontaneously or in association with certain diseases such as SLE, lymphoma, chronic lymphatic leukemia etc. The warm auto antibodies generally, incomplete non agglutinating antibodies, usually belong to the IgG class.

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It can be seen coating the erythrocytes in the direct Coombs test. The direct antiglobulin (Coombs’) test establishes the diagnosis and may suggest the cause. If symptoms are mild or if destruction of red blood cells seems to be slowing on its own, no treatment is needed. If red blood cell destruction is increasing, a corticosteroid such as prednisone is usually the first choice for treatment.

When people do not respond to corticosteroids or when the corticosteroid causes intolerable side effects, surgery to remove the spleen (splenectomy) is often the next treatment. The spleen is removed because it is one of the places where antibody- coated red blood cells are destroyed.

When destruction of red blood cells persists after removal of the spleen or when surgery cannot be done, immunosuppressive drugs, such as cyclophosphamide or azathioprine are used. When red blood cell destruction is severe, blood transfusions are sometimes needed, but they do not treat the cause of the anemia and provide only temporary relief.