Management of Severe Autoimmune Hemolytic Anemia: Incompatible Blood Transfusion as A Life-Saving Strategy

Background: Autoimmune hemolytic anemia (AIHA) presents with severe anemia requiring urgent transfusion, but serological incompatibility poses challenges. This study evaluates incompatible blood transfusions in AIHA, emphasizing minimal tests for patient safety. Methodology: This hospital-based cross-sectional study included 24 patients with primary autoimmune hemolytic anemia and severe anemia (hemoglobin <7 g/dL) evaluated between January 2023 and June 2025. Immunohematological tests, including direct antiglobulin test (DAT), indirect antiglobulin test (IAT), and antibody titration, confirmed AIHA and guided "best match" packed red blood cell (PRBC) selection. Results: Twenty-four patients (14 females, 10 males; mean age: 45 years, range: 18-72) with primary WAIHA and severe anemia (mean hemoglobin: 5.4 g/dL) were included. All patients were DAT and IAT positive, with antibody titers ranging from 64 to 512. A total of 264 PRBC units were crossmatched (mean: 11 units/patient), of which 73 units (27.7%) were identified as “best match.” Thirty-three units were transfused (mean: 1.4 units/patient), with a crossmatch-to-transfusion ratio of 8:1. No alloantibodies were detected. Adverse effects were minimal 21 patients (87.5%) had no complications, while 3 (12.5%) experienced mild chills that resolved with supportive care. No severe hemolytic transfusion reactions occurred. Conclusion: Incompatible transfusions, supported by minimal testing, are safe and effective in clinically imperative emergency situations of severe AIHA.