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

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.

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.

Anyone may develop Warm Antibody Hemolytic Anemia. Individuals with certain diseases which produce abnormalities of the immune system are at higher risk.

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" 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.)

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 its safety and effectiveness.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, in the main, contact:
www.centerwatch.com

TEXTBOOK
Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co; 1996:859-67.

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:872-73.

Hoffman R, et al., eds. Hematology Basic Principles and Practice, 2nd ed. New York, NY: Churchill-Livingstone, Inc; 1995:715-29.

REVIEW ARTICLES
Agarwal B, Autoimmune hemolytic anemia. Indian J Pediatr. 1998;65:663-68.

Chen FE, et al., Late onset haemolysis and red cell autoimmunization after allogenic bone marrow transplant. Bone Marrow Transplant. 1997;19:491-95.

JOURNAL ARTICLES
Castellino SM, et al., Erythrocyte autoantibodies in paediatric patients with sickle cell disease receiving transfusion therapy: frequency, characteristics, and significance. Br J Haematol. 1999;104:189-94.

Kondo H, et al., Direct antiglobin test negative autoimmune hemolytic anemia associated with autoimmune hepatitis. Int J Hematol. 1998;68:439-43.

Lang B, et al., Elevated anticardiolipin antibodies in autoimmune haemolytic anaemia irrespective of underlying systemic lupus. Lupus. 1997;6:652-55.

Slomkowski M, [A trial of treatment with thymus factor (TFX) for chronic autoimmune hemolytic anemia]. 1996;1:327-28. Polish.