Monocytosis, immunoglobulin M class autoantibody, and the intensity of the direct antiglobulin test may be useful in predicting mortality among patients with autoimmune hemolytic anemia (AIHA), including cold agglutinin disease (CAD), according to a study published in Transfusion and Apheresis Science. 

Efforts to treat patients with AIHA are hampered by a lack of a universally accepted diagnostic criteria and a lack of consensus over the best therapeutic strategy to adopt. This is in turn driven by a paucity of knowledge regarding the pathophysiological mechanisms underlying AIHA and possible factors that influence treatment response and survival. 

“This lack of knowledge about AIHA makes it difficult to identify patients at risk for refractory disease who will inevitably have reduced overall survival,” the authors of the study wrote. 

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They sought to assess various clinical and laboratory parameters to understand if any of them could be used as potential predictors of mortality in patients with this disorder. The research team conducted a retrospective study that included patients with AIHA who were seen at the Porto Alegre Hospital in Brazil from January 2000 to June 2019. For a diagnosis of AIHA to be accepted, the researchers required proof of the existence of anemia, hemolysis, and autoantibodies. 

Read more about CAD etiology 

One hundred thirty-eight patients were recruited for the study. The researchers were able to access the clinical and laboratory data of these individuals and gather important data regarding therapeutic decisions (such as blood transfusions and splenectomies) and laboratory parameters (such as monocyte levels, direct antiglobulin test severity, presence of alloantibodies upon diagnosis, and the presence of concurrent infections). The researchers were then able to compare the data obtained with treatment response and survival outcomes. 

The authors reported several parameters that correlated with mortality. For example, they reported that monocytosis detected upon diagnosis was associated with decreased overall survival. They also discovered that immunoglobulin M antibody class was linked to survival, in contrast to other antibody classes. In addition, they reported that the close monitoring of patients via the direct antiglobulin test test may improve survival. 

“This article links clinical, laboratory and immunohematological nuances to mortality, looking for predictors for this outcome in AIHA patients,” they summarized. 


Durigon G, Sekine L, Franz JPM, Fogliatto LM, da Rocha Silla LM. Aspects of laboratory characteristics, analysis of alloimmunization, and searching for predictors related to survival in patients with autoimmune hemolytic anemiaTransfus Apher Sci. Published online May 25, 2023. doi:10.1016/j.transci.2023.103741