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",{"id":215,"name":216},1,"Course previews",[218,229,234,239],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},317,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Treating a pregnant patient","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=ZQGfuxoHQEw",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},14.4,"\u003Cp> \u003Cstyle type=\"text\u002Fcss\">\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--> \u003C\u002Fstyle> We often see anemic patients in the clinic, and one of the important differentials in adults is autoimmune hemolytic anemia. In this video, from our Transfusion Medicine Essentials course, you’ll discover the lab findings that will help you to diagnose this condition and the tests you can use to differentiate hemolytic anemia caused by autoimmune responses and anemia that stems from other causes. \u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},18.4,"Join our Transfusion Medicine Essentials course today!","\u003Cp>Learn how to confidently choose the right blood product, at the right time, for your patients! With our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Ftransfusion-medicine-essentials\">Transfusion Medicine Essentials\u003C\u002Fa> course, you'll master the administration of blood products, understand how blood typing works, determine when it's okay to skip some parts of the testing, learn how to deal with complications, identify blood group constellations in pregnancy, and apply your knowledge to real-life patient cases. \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister\">Start your free trial now!\u003C\u002Fa>\u003C\u002Fp>",{"type":230,"data":240},{"readDurationInSeconds":241,"title":242,"text":243},141.06666666666666,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:00:00] \u003C\u002Fb>We often see patients with anemia in our clinical routine. They present with symptoms such as paleness, fatigue or tachycardia. If the anemia is only mild, there might be no specific symptoms at all. One of the differentials that is common in adults is hemolytic anemia. So what lab findings can help you diagnose hemolysis? If hemolysis is present, you'll find elevated LDH, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:00:30] \u003C\u002Fb>elevated bilirubin, reticulocytosis, a decrease in haptoglobin, and if intravascular hemolysis is present, you should see a significant elevation of free hemoglobin and hemoglobinuria. Once you see a laboratory finding suggesting hemolytic anemia, you should immediately consider the most common cause of hemolytic anemia in adults, autoimmune hemolytic anemia. So what happens in autoimmune hemolysis? \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:01:00] \u003C\u002Fb>Basically, antibodies that are directed against individual's own red blood cell antigens, so-called autoantibodies attack the RBCs and cause them to burst. The loss of functional red blood cells leads to anemia. These autoantibodies can be of different immunoglobulin classes IgG, IgM or IgA in some cases. The complement system is also activated. Why some individual's immune systems attack their own cells is not entirely \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:01:30] \u003C\u002Fb>understood. 50% of all cases of autoimmune hemolysis are idiopathic so we just don't know why they happen. The other 50% result from secondary causes. Diseases or conditions that are known to induce autoimmune hemolysis include neoplasms, especially lymphoproliferative disorders like lymphoma or chronic lymphocytic leukemia but also other neoplasms; autoimmune diseases like systemic lupus, rheumatoid arthritis, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:02:00] \u003C\u002Fb>inflammatory bowel diseases, and others; infections by mycoplasma, viral pneumonia or infectious mononucleosis or drugs like penicillin, diclofenac or methyldopa. So, how can I verify that the hemolysis I see is autoimmune? To determine whether the hemolysis is autoimmune in nature, the transfusion lab performs the direct antiglobulin test, DAT for short. To perform this test, you need the patient's RBCs \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:02:30]\u003C\u002Fb> and antibodies to bind to IgG antibodies, which are known as antiglobulin antibodies or Coombs serum. Basically, we want to verify that the patient’s red blood cells have already been attacked by antibodies that cause hemolysis. In order to do this, you mix the patient's RBCs with the antiglobulin antibodies and incubate them. If the patient's RBCs are covered with IgG antibodies, the antiglobulin antibodies will bind to the IgGs on the RBC surface \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:03:00]\u003C\u002Fb> and agglutinate the RBCs. Agglutination can be seen microscopically. In this case, the direct antiglobulin test is positive. You are dealing with autoimmune hemolysis. The lab can go on to determine the specificity of the autoantibodies and whether the complement pathway is activated. These results, plus a proper medical history, help to narrow down the cause of the autoimmune process and lead the way to the best treatment option. If there are no autoantibodies on \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:03:30] \u003C\u002Fb>the patient's RBCs, the antiglobulin serum has nothing to bind to so there will be no agglutination. The DAT is negative. There must be a non-autoimmune reason for hemolysis so keep on searching for differentials. So does a positive DAT always indicate an autoimmune process? The answer is no. A positive DAT will not only indicate autoimmune hemolytic disease but also recent hemolysis caused by the incompatibility of red blood cell antigens \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:04:00] \u003C\u002Fb>and antibodies. There are two possible reasons for the latter, hemolytic transfusion reaction following incompatible blood transfusion and hemolytic disease of the newborn. In these two cases, RBCs might be covered with IgG antibodies as well. However, these would be alloantibodies instead of autoantibodies. The DAT will induce agglutination of discovered RBCs just the same. So in these situations, the DAT helps you to show that hemolysis is taking place right now. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-ff819907-7fff-0873-5563-414402c439be\">[00:04:30] \u003C\u002Fb>Autoimmune hemolytic anemia is an important differential in the workup of anemia. The direct antiglobulin test is a fast and cheap test to help you diagnose it. Furthermore, it can help you determine how recent hemolytic processes are in situations of blood group incompatibilities like after an incompatible transfusion or newborns affected with hemolytic disease of the fetus and newborn.\u003C\u002Fp>",{"courses":245,"showAwardsBelow":48},[246],{"id":247,"isFreeCmeCourse":248,"title":249,"type":250,"specialization":251,"teachers":253,"cmeCredits":255,"teacherIllustration":256,"backgroundImage":257,"relativeUrl":258,"lastChanged":259,"created":260,"description":261,"relativeURL":258,"meta":262},5865,false,"Transfusion Medicine Essentials","course",[252],"Hematology",[254],"Anna Wonnerth, MD",4,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e95-ef8e-4152-ae5d-a862895a2f5e","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e96-eaba-4482-8562-f3b21703ef69","\u002Fcourses\u002Ftransfusion-medicine-essentials","1779178829","1547131874","Confidently choose the right blood product for your patient at the right time. 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You’ll be prepared to administer basic transfusions, ready to deal with special situations like pregnancy, and manage complications, should they arise.",{"duration":263,"quizzes":264,"lessons":265},8583,8,47,{"id":267,"name":254,"image":268,"profession":269,"relativeUrl":272,"specializations":273},4459,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef9-4f55-4a08-8e1e-cc9919550b37",{"name":270,"description":271},"Laboratory medicine specialist","Anna is a Certified Family Physician and Specialist in Clinical Chemistry.","\u002Fteachers\u002Fanna-wonnerth-md",[274,275,252],"Infectious diseases","Cardiology",180,"3m",[279,306,324],{"id":280,"title":281,"text":282,"image":283,"author":291,"path":299,"readDuration":300,"readDurationFormatted":301,"internal":302},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":284,"title":285,"size":286,"location":288},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle","",{"width":287,"height":287},660,{"bucket":289,"key":290},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(2)_magazine image.png",{"id":292,"title":293,"relativeURL":294,"image":295,"professionLong":296,"profession":297,"weight":255},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":298},"Internist","\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,"4m",{"created":303,"updated":304,"published":305},1778960150,1779196374,1778961827,{"id":307,"title":308,"text":309,"image":310,"author":316,"path":318,"readDuration":319,"readDurationFormatted":277,"internal":320},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":311,"title":285,"size":312,"location":314},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":313,"height":313},1200,{"bucket":289,"key":315},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":292,"title":293,"relativeURL":294,"image":295,"professionLong":296,"profession":317,"weight":255},{"name":298},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":321,"updated":322,"published":323},1778115738,1778799792,1778118255,{"id":325,"title":326,"text":327,"image":328,"author":334,"path":336,"readDuration":337,"readDurationFormatted":338,"internal":339},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":329,"title":285,"size":330,"location":332},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":331,"height":331},600,{"bucket":289,"key":333},"\u002F2026-04\u002FC121_magazine image.png",{"id":292,"title":293,"relativeURL":294,"image":295,"professionLong":296,"profession":335,"weight":255},{"name":298},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":340,"updated":341,"published":342},1777403036,1777572381,1777412421,{"seo":344,"og":346},{"title":345,"description":213},"Autoimmune hemolytic anemia | Medmastery",{"title":345,"description":213,"image":347},{"alt":285,"title":285,"size":348,"location":351},{"width":349,"height":350},688,403,{"bucket":289,"key":352},"\u002Fmigrated-images\u002FScreen Shot 2019-01-16 at 2.42.55 pm.png",{"id":354,"created":355,"updated":356,"published":355},290,1550409473,1655189586]