Clinical Features Clinical features of AIHA include symptomatic anemia, jaundice, and often splenomegaly. In addition, characteristic findings of the associated LPD are pres-ent. The diagnosis of AIHA can be suspected by a review of the peripheral blood smear that reveals characteristic findings of polychromasia, indicative of reticulocytosis, and spherocytes. The definitive diagnosis of AIHA rests on demonstration of immunoglobulin or complement bound to red blood cells. The direct antiglobulin test can determine whether red blood cells are coated with IgG alone, complement alone, or IgG and complement.
Further testing can determine the specificity of the autoantibody.
The pathogenesis of AIHA in CLL is not clear. Most evidence would suggest that these autoantibodies are not products of the malignant clone. Recently, however, two studies have suggested otherwise. In these studies, eluted autoantibodies from red blood cells of two patients with AIHA expressed the same monotypic light chain as the CLL clone. Cytotoxic agents such as cyclophosphamide can be prescribed in cases of prednisone failure.