Researchers reported the characteristics and outcomes of adult patients with severe autoimmune hemolytic anemia (AIHA) admitted to the intensive care unit (ICU), as presented at the 63rd American Society for Hematology Annual Meeting & Exposition.

AIHA is known to carry a poor prognosis and studies have indicated that the overall mortality rate is between 8% to 10%, which can rise to 30% for patients admitted into ICU care. The research team decided to carry out an observational multicenter study to better understand the prognostic indicators of patients with severe AIHA admitted into ICU care. 

The inclusion criteria of this study included patients having primary or secondary AIHA (including cold agglutinin disease), with at least 1 ICU admission specifically for the management of worsening AIHA. The researchers then conducted additional investigations to identify factors associated with death in ICU or after 1 year of follow-up. 


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Pouchelon et al managed to recruit 62 patients from 11 medical centers. Their findings on adult AIHA that received ICU care demonstrated extremely poor prognoses. A majority of patients had impaired erythropoiesis and the mortality rate was 13%.

Comparing the 8 patients who died during ICU care with the remaining 54 who survived, patients in the ICU had a higher C-reactive protein level, a higher need for blood transfusions, a higher number of organ failures upon admission, and a greater chance of experiencing sepsis or thromboembolic events during their hospital stays. 

The researchers then compared the characteristics of 62 patients with 138 controls with AIHA who never received ICU care. “In univariate analyses, younger age, Evans’ syndrome, Hb [hemoglobin] level < 6 g/dl; reticulocytes count < 100 x 109/L, [bone marrow reticulocyte index] <121 and high bilirubin level were significantly associated with an admission in ICU,” they said.

“Patients with AIHA and a Hb level < 6g/dl, a high bilirubin level and/or an inadequate reticulocytes count must be treated promptly and monitored closely beyond the initial phase of the disease in order to reduce the mortality rate,” they concluded.

Reference

Pouchelon C, Lafont C, Lafarge A, et al. Characteristics and outcome of adults with severe autoimmune hemolytic anemia admitted in intensive care unit: results from a large French observational study. Poster presented at: 63rd American Society for Hematology Annual Meeting & Exposition: December 11, 2021; Atlanta, Georgia.