Autoimmune cytopenia in the intensive care unit: Diagnosis and management

Abstract

Immune thrombocytopenia (ITP) and autoimmune haemolytic anemia (AIHA) are the two main autoimmune cytopenias in adults. AIHA includes AIHA associated with warm autoantibodies and cold agglutinin-mediated anemia (CAA). Treatment of the most severe forms of ITP is based on high-dose steroids and intravenous immunoglobulins (IVIg). Platelet transfusions are indicated only for life-threatening bleedings. High-dose steroids represent the first-line treatment of warm AIHA. Red blood cell transfusions are effective for symptomatic anemia. Splenectomy should only be performed in the exceptional cases refractory to medical treatment. In CAA, transfusion of warmed packed red blood cells is the unique emergent therapy. Steroids are not effective and should be avoided. Anti-CD20 antibodies represent a promising therapy for warm AIHA and CAA and should be administered if first-line treatment has failed.