Immune hemolytic anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to the body's tissues.
Red blood cells last for about 120 days before the body gets rid of them. In hemolytic anemia, red blood cells in the blood are destroyed earlier than normal.
Immune hemolytic anemia occurs when antibodies form against the body's own red blood cells and destroy them. This happens because the immune system mistakenly recognizes these blood cells as foreign.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...

Anemia - Animation
Do you feel tired and listless? Do you find your mind drifting during the day? Do you get dizzy or short of breath whenever you climb the stairs? There are a few possible reasons for the way you feel, but you could have anemia. You could even have anemia without noticing any symptoms at all. Anemia is a problem with hemoglobin, a substance in red blood cells that carries oxygen throughout your body. Without enough hemoglobin, your heart and other organs can't get the oxygen they need to work. When your organs slow down, you slow down and you start feeling tired and listless. Many different health conditions can cause anemia, from heavy blood loss during a woman's period, to pregnancy, to an underactive thyroid gland. Healthy red blood cells are made in your bone marrow, the soft tissue in the middle of your bones. Any disease that damages blood marrow, such as lymphoma or leukemia, can also affect your red blood cell production. Anemia can also be caused by an immune system problem that damages red blood cells, or surgery to the stomach or intestines. How do you know if you have anemia? You may feel tired, dizzy, and have trouble concentrating. You may get sick more often. People with anemia often complain of chest pain, headaches, or shortness of breath. Your skin might look pale, like you haven't seen the sun for months. Because these can also be symptoms of other conditions, your doctor will confirm that you have anemia by taking a blood test to check your red blood cell count and hemoglobin level. Blood tests can also look for problems that may be causing your anemia, such as a vitamin or iron deficiency. If you are anemic, it's very important to treat it. When your body isn't getting enough oxygen, it can starve vital organs like your heart. This can lead to a heart attack. How you treat anemia really depends on the cause. If the problem is with your bone marrow, you may take a medicine called erythropoietin, which will help your bone marrow make more red blood cells. If the problem is a vitamin or mineral deficiency, your doctor may prescribe iron, vitamin B12, or folic acid supplements. Or, you may need a blood transfusion to replace damaged red blood cells with healthy ones. How well you do really depends on what's causing your anemia. Call your doctor if you have any symptoms like fatigue or shortness of breath. Once your doctor can find and treat the cause of your anemia, you should have more energy and start feeling like your old self again.
Causes
Possible causes include:
- Certain chemicals, medicines, and toxins
- Infections
- Transfusion of blood from a donor with a blood type that does not match
- Certain cancers
When antibodies form against red blood cells for no reason, the condition is called idiopathic autoimmune hemolytic anemia.
Antibodies
An antibody is a protein produced by the body's immune system when it detects harmful substances, called antigens. Examples of antigens include micr...

The antibodies may also be caused by:
- A complication of another disease
- Past blood transfusions
- Pregnancy (if the baby's blood type is different from the mother's)
Risk factors are related to the causes.
Symptoms
You may not have symptoms if the anemia is mild. If the problem develops slowly, symptoms that may occur first include:
- Feeling weak or tired more often than usual, or with exercise
- Headaches
- Problems concentrating or thinking
If the anemia gets worse, symptoms may include:
- Lightheadedness when you stand up
- Pale skin color (pallor)
Pallor
Paleness is an abnormal loss of color from normal skin or mucous membranes.
Read Article Now Book Mark Article - Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
ImageRead Article Now Book Mark Article - Sore tongue
Exams and Tests
You may need the following tests:
- Absolute reticulocyte count
Reticulocyte count
Reticulocytes are slightly immature red blood cells. A reticulocyte count is a blood test that measures the amount of these cells in the blood....
ImageRead Article Now Book Mark Article - Direct or indirect Coombs test
Coombs test
The Coombs test looks for antibodies that may stick to your red blood cells and cause red blood cells to die too early.
Read Article Now Book Mark Article - Hemoglobin in the urine
Hemoglobin
Hemoglobin is a protein in red blood cells that carries oxygen. The hemoglobin test measures how much hemoglobin is in your blood.
ImageRead Article Now Book Mark Article - LDH (level of this enzyme rises as a result of tissue damage)
LDH
Lactate dehydrogenase (LDH) is a protein that helps produce energy in the body. An LDH test measures the amount of LDH in the blood.
Read Article Now Book Mark Article - Red blood cell count (RBC), hemoglobin, and hematocrit
Red blood cell count
An RBC count is a blood test that measures how many red blood cells (RBCs) you have. RBCs contain hemoglobin, a protein which carries oxygen. How mu...
ImageRead Article Now Book Mark ArticleHematocrit
Hematocrit is a blood test that measures how much of a person's blood is made up of red blood cells as opposed to plasma. This measurement depends o...
ImageRead Article Now Book Mark Article - Serum bilirubin level
Bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
ImageRead Article Now Book Mark Article - Serum haptoglobin
Serum haptoglobin
The haptoglobin blood test measures the level of haptoglobin in your blood. Haptoglobin is a protein produced by the liver. It attaches to hemoglobi...
Read Article Now Book Mark Article - Donath-Landsteiner test
- Cold agglutinins
- Platelet count
- Protein electrophoresis - serum
- Pyruvate kinase
Treatment
The first treatment tried is most often a steroid medicine, such as prednisone. If a steroid medicine does not improve the condition, treatment with intravenous immunoglobulin (IVIG) or removal of the spleen (splenectomy) may be considered.
You may receive treatment to suppress your immune system if you do not respond to steroids. Medicines such as azathioprine (Imuran), cyclophosphamide (Cytoxan), and rituximab (Rituxan) have been used.
Blood transfusions are given with caution, because the blood may not be compatible and it may cause more red blood cell destruction.
Outlook (Prognosis)
The disease may start quickly and be very serious, or it may stay mild and not need special treatment.
In most people, steroids or splenectomy can totally or partially control anemia.
Possible Complications
Severe anemia rarely leads to death. Severe infection may occur as a complication of treatment with steroids, other medicines that suppress the immune system, or splenectomy. These treatments impair the body's ability to fight infection.
When to Contact a Medical Professional
Contact your health care provider if you have unexplained fatigue or chest pain, or signs of infection.
Prevention
Screening for antibodies in donated blood and in the recipient may prevent hemolytic anemia related to blood transfusions.
Reviewed By
Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Michel M. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 146.
Michel M, Jäger U. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 47.
Wong E, Rose MG, Berliner N. Disorders of red blood cells. In: Wing EJ, Schiffman FJ, eds. Cecil Essentials of Medicine. 10th ed. Philadelphia, PA: Elsevier; 2022:chap 48.