Profil Pasien Anemia Hemolitik Auto Imun (AHAI) dan Respon Pengobatan Pasca Terapi Kortikosteroid di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo

Introduction. Autoimmune hemolytic anemia (AIHA) is one of the immunological diseases that causes hemolysis. Data on demographic characteristics and treatment response of AIHA patients has not available in Indonesia. This study was conducted to identify the profile of autoimmune hemolytic anemia (AIHA) patients and their response of treatment after receiving corticosteroid treatment. Methods. This cross-sectional study used data from the medical records of AIHA patients in the outpatient clinic division of the Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Hospital between 2004-2008 which included: patient demography characteristics, AIHA classification and etiology, as well as the response of treatment to initial dose of corticosteroid, equivalent to prednisone 1-1,5 mg/kgbw/day for 3-4 weeks; with positive response marked by increase of Hb >10 g/dL. Results. From total of 50 subjects, the proportion of warm type, cold type and mix type were 92%, 6% and 2%, respectively. Most of the etiology of AIHA warm type was idiopathic or primary (54.3%), whereas the etiology of secondary type were systemic lupus erythematosus/LES (41.3%), autoimmune hepatitis (2.2%) and chronic lymphocytic leukemia (2.2%). Characteristics of serological Coombs tests on AIHA warm type were combination of anti-IgG + anti-C3 (84.8%) and the anti-IgG (15.2%). Meanwhile, the proportion of subjects with AIHA warm type that has a positive response to corticosteroids were 71.7%. This study found that the etiology of AIHA cold type were idiopathic or primary (66.7%) and multiple myeloma (33.3%). Coombs tests showed an anti-C3 and cold antibody and all subjects had negative response to corticosteroids. This study also found the etiology of AIHA mixed type was primary, had positive response to corticosteroids and Coombs test demonstrated anti-IgG + anti-C3 accompanied by a non-specific antibody with high titer. Conclusions. The majority of AIHA subjects are warm type AIHA, with a small portion being cold and mixed type. The proportion of warm type AIHA that respond positively to corticosteroids is 71,7%. All cold type AIHA subjects do not respond to corticosteroids while mixed type AIHA subjects show positive response.