Navigating Autoimmune Hemolytic Anemia in Expectant Mothers

Autoimmune hemolytic anemia is when your immune system makes antibodies that attack your own red blood cells, leading to a drop in their numbers and causing anemia. The good news is that it’s possible to diagnose and treat this condition, so it’s good to be informed.

The causes of autoimmune hemolytic anemia fall into two categories: primary and secondary. The primary cause is unknown and accounts for half of the cases. The other half are due to secondary factors.

Secondary autoimmune hemolytic anemia comes in two types: warm-type and cold-type. Warm-type can be triggered by conditions like systemic lupus erythematosus, scleroderma, Crohn’s colitis, rheumatoid arthritis, chronic lymphocytic leukemia, and lymphoma. Sometimes, infections and non-lymphoid cancers can cause it. Cold-type is often caused by lymphoproliferative conditions and infections such as viral pneumonia, infectious mononucleosis, and mycoplasma.

The symptoms of autoimmune hemolytic anemia include pale skin, fatigue, dizziness, heart palpitations, shortness of breath, and in severe cases, loss of consciousness or death. The breakdown of red blood cells releases bile into the bloodstream, which can cause jaundice, itchy skin, and dark urine.

During pregnancy, you might also encounter physiological anemia, which is expected and manageable. Around the second or third month, your body produces more plasma, diluting the red blood cells and causing anemia-like symptoms. This isn’t due to the destruction of red blood cells but rather their decreased concentration. Supplementing with iron helps your body make more red blood cells and increases their concentration.

Before 2015, autoimmune hemolytic anemia caused by pregnancy wasn’t well-documented in medical literature. Most cases occur in the later stages of pregnancy and respond well to steroid treatments, with or without blood transfusions, without harming the baby. Sometimes, it resolves on its own after pregnancy.

However, this condition can be dangerous for both mother and baby, especially if the antibodies are immunoglobulin G, which can cross the placenta and affect the baby. While therapies to reduce the autoimmune response are generally effective, there are cases where they don’t work. In one instance, a mother with severe anemia and warm-type autoimmune hemolytic anemia didn’t respond to standard treatments. Her baby was delivered at 30 weeks, and both were treated successfully with steroids, blood transfusions, and phototherapy, recovering fully within a few weeks.

Another study showed two women diagnosed with warm-type autoimmune hemolytic anemia in the late third trimester responded well to steroid therapy without needing transfusions, and healthy babies were born without signs of hemolysis.

The key takeaway is that autoimmune hemolytic anemia is treatable. Recognize the symptoms and understand their impact on pregnancy. While further research is needed to fully understand this condition, the main goal of treatment is to stop the destruction of red blood cells and correct the anemia.