Acquired Autoimmune Hemolytic Anemia

Acquired autoimmune hemolytic anemia, or AIHA, is a rare type of anemia. When you have anemia, your bone marrow doesn't make enough red blood cells. Or, these cells don't work as well as they should.

Red blood cells carry oxygen to your body. When you have too few red blood cells, your body can't get enough oxygen, leaving you feeling tired or short of breath.

What is AIHA?

Red blood cells are made in the spongy material called bone marrow deep inside your bones.

These blood cells normally live for about 120 days.

If you have hemolytic anemia, your body destroys red blood cells faster than your bone marrow can make new ones. Sometimes these red blood cells live for only a few days.

Acquired autoimmune hemolytic anemia is a type of hemolytic anemia. The “acquired” part means you weren't born with this anemia. Another disease or other trigger caused it. “Autoimmune” means your body's immune system attacks and destroys your red blood cells.

What Causes It?

You can get acquired autoimmune hemolytic anemia if you have an autoimmune disease such as lupus. Normally when your immune system spots foreign invaders like bacteria and viruses, it makes proteins called antibodies to attack them. When you have AIHA, your immune system makes antibodies that mistakenly attack your own red blood cells.

Other diseases and medications can also cause autoimmune hemolytic anemia. Some of these are:

Symptoms of AIHA

People with acquired autoimmune hemolytic anemia have symptoms that include:

  • Chills
  • Fast heartbeat, known as tachycardia
  • Pale skin that may start to yellow
  • Shortness of breath
  • Weakness and fatigue
  • Chest pain
  • Yellow skin or whites of the eyes (jaundice)
  • Dark urine
  • A feeling of abdominal fullness related to an enlarged spleen


How Is AIHA Diagnosed?

If you think you could have any type of anemia, you should talk to your primary doctor. He may refer you to a hematologist, a doctor who specializes in blood diseases. He’ll most likely discuss your past medical history, medications you take, and talk about your symptoms.


He’ll also request a blood test called a complete blood count, or CBC, to look for signs of anemia. This test measures:

  • The number of red blood cells, white blood cells, and platelets
  • The size of your red blood cells
  • The protein in your red blood cells that carries oxygen (hemoglobin)
  • How much space red blood cells take up in your blood (hematocrit)

A low red blood cell count and low hemoglobin and hematocrit levels are signs of anemia.

If your CBC test results point to anemia, your doctor might want to do further testing. Some common tests for acquired autoimmune hemolytic anemia that he might order include:

Reticulocyte count. This measures the number of young red blood cells in your body. A high reticulocyte count means your bone marrow is making a lot more cells to replace the ones your body has destroyed.

Coombs' test. Your doctor will do this test to see if your body is making antibodies against red blood cells.

Peripheral smear. Your doctor will look at your red blood cells under a microscope to see evidence of blood cell destruction.

Chemistry test. Your doctor may order a test to check for the level of bilirubin, a substance that increases when blood cells are destroyed.

Treating AIHA

If you have a disease like lupus that’s causing your anemia, your doctor will treat it first. If a medication is the cause, you'll likely have to stop taking that medicine. If your AIHA is mild, you may not need any treatment at all.

Doctors usually first prescribe steroids, such as hydrocortisone or prednisone, to stop your immune system from attacking your red blood cells. Then surgery to remove the spleen and a medicine called rituximab may be ordered. And other medicines such as azathioprine (Imuran) and cyclophosphamide (Cytoxan) can be used to suppress the immune system.

Blood transfusions may also be needed in some cases.


WebMD Medical Reference Reviewed by Louise Chang, MD on September 15, 2018



American Association of Clinical Chemistry: "Hemolytic Anemias."

National Heart, Lung, and Blood Institute: "How is Hemolytic Anemia Diagnosed?" "Types of Hemolytic Anemia," "What Are the Signs and Symptoms of Hemolytic Anemia?"  "What Is Anemia?"

National Organization for Rare Disorders: "Anemia, Hemolytic, Acquired Autoimmune."

Orphanet: "Autoimmune hemolytic anemia."

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