PROBLEMS AND PROSPECTS IN THE MANAGEMENT OF HEMOLYTIC ANEMIAS: A NARRATIVE REVIEW
Keywords:
hemolytic anemia, autoimmune hemolytic anemia, direct antiglobulin test, rituximab, paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis, complement inhibitors, differential diagnosis.Abstract
Objective: To systematize current evidence on diagnostic and therapeutic challenges in hemolytic anemias (HA) of various origins, identify key contradictions in existing approaches, and outline directions for further research.
Methods: A narrative literature review was conducted covering the period 2020–2026 using PubMed, Scopus, and Google Scholar databases. Search queries included: "hemolytic anemia diagnosis," "autoimmune hemolytic anemia treatment," "hereditary spherocytosis," "paroxysmal nocturnal hemoglobinuria," "warm autoimmune hemolytic anemia." Twenty-one sources meeting inclusion criteria were selected: original studies, systematic reviews, and clinical guidelines.
Results: The diagnosis of HA remains a multi-layered challenge: the direct antiglobulin test (DAT) yields false-negative results in 2–11% of autoimmune HA (AIHA) cases, and differential diagnosis between hereditary and acquired forms frequently takes months. Glucocorticosteroid (GCS) therapy for AIHA is effective in 70–85% of patients in the short term, yet relapse occurs in 30–40%. Rituximab and newer targeted agents — complement inhibitors and anti-CD38 — are reshaping the therapeutic landscape, but the evidence base for several HA subtypes remains limited. Molecular genetic methods in hereditary HA are being adopted unevenly.
Conclusions: Hemolytic anemias are a heterogeneous group of conditions for which a unified diagnostic algorithm is not applicable. Prospective multicenter studies, standardization of laboratory protocols, and the development of personalized therapeutic strategies are required.
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