الفهرس 
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Abstract
Autoimmune hemolytic anemia (AIHA) is one of the major causes of acquired hemolytic anemias in which the patient’s red blood cells (RBCs) are selectively attacked and destroyed (hemolyzed) by autoantibodies produced by the patient’s own immune system. Aim of present study was to evaluate autoimmune hemolytic patients’ characteristics, detect the correlation between the different confounders and the severity of anemia at onset with the clinicaloutcome, asses the response to different modalities of the first line treatment. PATIENTS AND METHODS: The study was performed at Clinical Hematology Unit and its outpatient clinic of the Internal Medicine Department, Assiut University. The present study is a prospective observational study was performed at period between June 2017 and January 2020. 160 eligible newly diagnosed AIHA patients were recruited and each patient monitored for at least one year. a. Inclusion criteria: Patients diagnosed warm auto Immune hemolytic anemia primary or secondary (CLL, Lymphoma, RA, SLE, Drug induced) b. Exclusion criteria: All types of congenital hemolytic anemia, Microangipathic hemolytic anemia (TTP, HUS, and DIC), Alloimmune hemolytic anemia and cold AIHAAll the patients included in this study subjected to the following: Full history taking including name, age, sex, smoking status, history of chronic diseases and history of drug intake. Through clinical examination including: general examination including; arterial blood pressure, pulse pressure, respiratory rate, temperature, urine output, thorough chest, cardiac and abdominal examination To all patients the following investigations were performed. Complete blood count, Coagulation profile including PT and APTT, Liver function tests. , Direct antiglobulin test (DAT), serology including HIV, HBV, HCV, ANA &Anti ds DNA, Serum lactate dehydrogenase (LDH) study and BM studies if indicated. Follow up clinical response and laboratory investigations were done after 4 weeks. imaging : Ultrasonography , CT chest, abdomen, and pelvis Results: Present study included 160 patients had a median age (IQR) 37.5 (27) years ranging from 18 to 80 years and comprised 48 males (30 %) and 112 females (70 %). The mean BMI was 27.4. Primary AIHA represents 68.1% of the cases. Only 10 participants (6.3%) reported enlarged lymph nodes, while hepatomegaly was exhibited by 23 (14.4 %) and splenomegaly found in 27 (16.9 %) subjects, respectively. There was statically significant difference between primary and secondary types regarding their age (median, IQR) and the WBCs with a trend to be older in the secondary AIHA group and higher at WBCs. Among primary AIHA patients (109), 13 (11.9%) patients were Evans syndrome. SLE was the most common cause of secondary AIHA followed by CLL. There was significant difference between both types of AIHA regarding severity of the anemia at diagnosis as it is more sever in primary AIHA group. There was not any statistical significance between the two types of AIHA regarding the response parameters at the end of 4-weeks follow-up, the p value was 0.26. there was significant response to first line treatment as it appeared an increase between the hemoglobin level at diagnosis and at 1-month post treatment follow up of the whole population (p- value = 0.0001). There was statistical significant increase of Hgb level (Median , IQR ) 4 weeks post treatment in response to oral prednisolone and pulsed dexamethasone more than that achieved in groups taking methylprednisolone either for 3 days or 5 days as first line treatments, the p value was 0.001 . There was no statistically significant difference between primary and secondaryAIHA patients regarding who needed second line treatment during the first year follow up where the p value was 0.9. Among the total patients (149) at the end of the study, only 34 patients needed second line treatment including 23 patients with primary AIHA and 11 patients with secondary AIHA