why choose us

300×250 Ad Slot

Research Article: Clinical characteristics, treatment patterns and long-term outcomes of warm and mixed autoimmune hemolytic anemia: insights from a real-world study

Date Published: 2026-10-12

Abstract:
Autoimmune hemolytic anemia (AIHA) represents a heterogeneous group of autoimmune disorders, with limited large-scale real-world evidence from Asian populations. This study aimed to characterize the clinical characteristics, treatment patterns, and long-term outcomes of patients with warm AIHA (wAIHA) and mixed AIHA (mAIHA). This single-center retrospective study screened 629 patients with AIHA hospitalized in China between 2014 and 2023. After excluding 32 patients with cold AIHA and 31 with DAT-negative AIHA, 566 patients (449 wAIHA and 117 mAIHA) were included, with a median follow-up of 57 months. Compared with wAIHA, mAIHA patients presented with earlier onset, poorer bone marrow compensation, and cold AIHA-like features despite comparable hemoglobin levels. Secondary AIHA was more prevalent in mAIHA (39.3% vs. 22.5%). Glucocorticoids remained the first-line treatment with similar response rates in both subtypes, while rituximab was the predominant second-line therapy. Treatment strategies and outcomes with multiple emerging therapies were also summarized. Median event-free survival was 17 months, with relapses mainly occurring during treatment tapering or infections. Estimated overall survival (OS) rates at 1, 3, and 5 years were 96%, 92%, and 89%, respectively, with infections and disease progression being leading causes of mortality. Independent risk factors associated with OS included age ?60, hemoglobin at onset <6 g/dL, bone marrow responsiveness index <121, male sex, and an IgM+IgA-mediated serological pattern, whereas cold agglutinin titers demonstrated limited value in predicting OS or treatment response. mAIHA and wAIHA share comparable glucocorticoid response and long-term survival despite distinct clinical and serological characteristics. This large real-world cohort delineates the profiles of wAIHA and mAIHA and identifies baseline factors associated with OS to support individualized management. Emerging therapies present promising prospects in AIHA management.

Introduction:
Autoimmune hemolytic anemia (AIHA) is a group of anemias characterized by autoantibody-mediated destruction of red blood cells (RBCs). As the most prevalent form of acquired hemolytic anemia, AIHA is marked by its clinical heterogeneity, unpredictable disease progression, high relapse rates and thrombotic risk ( 1 – 4 ). Based on underlying etiology, AIHA is divided into primary and secondary forms ( 5 ). Direct antiglobulin test (DAT) and cold agglutinin (CA) level remain the diagnostic cornerstones for AIHA,…

Read more

300×250 Ad Slot