Warm Autoimmune Hemolytic Anemia: Challenges, Choices, and New Therapies

In this episode of Heme Talks, we are joined by Allyson Pishko, MD, MSCE, Classical Hematologist and Assistant Professor of Medicine at the University of Pennsylvania, to discuss a rare blood disorder known as warm autoimmune hemolytic anemia (wAIHA). In this episode, Dr. Pishko shares her approach to diagnosis and management of this disorder, and how she approaches discussions about this diagnosis with her patients. Dr. Pishko also discusses promising future options for patients with wAIHA. Clinical Perls:Warm autoimmune hemolytic anemia is a complex diagnosis. In addition to a careful history, key lab data to support the diagnosis can include an acute drop in hemoglobin, elevated bilirubin, elevated lactate dehydrogenase (LDH), reduced haptoglobin, an elevated reticulocyte count, and a positive Coombs’ test. Microspherocytes may also be visible on a smear. However, not all patients will present with all of these findings, and it is also important to consider the patient’s comorbid conditions when interpreting labs.  Corticosteroids remain the backbone of treatment with a slow taper over many weeks pending clinical improvement. Additional therapies include rituximab and immunosuppressive agents. For refractory patients, additional options to consider agents including fostaminib and rilzabrutinib. Nipocalimab is currently also being reviewed by the FDA.  This podcast episode is supported by Johnson & Johnson.