The prognosis in warm AIHA depends on a number of variables, including age, associated diseases and severity of haemolysis. In all patients, AIHA should be considered a serious and potentially life-threatening disease. Estimates of mortality of idiopathic AIHA in adults vary from 10% at 5 years to 40% at 7 years. The higher figures are mainly in patients aged over 50 years. Most deaths occur in the first 2 years after diagnosis. In children, mortality is much lower, probably about 5%, with the majority of patients recovering completely. Apart from death, AIHA may carry considerable morbidity, particularly from prolonged high-dose steroid therapy.
The clinical features of the cold haemagglutinin syndromes vary with the pathogenesis of the disorder. Serological tests are useful in identifying the cause and in determining treatment. The serological characteristics of the antibodies found in these syndromes are shown in Table 10.2.
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