Causes Of Autoimmune Hemolytic Anemia

Autoimmune hemolytic anemia is an autoimmune disorder in which red blood cells are destroyed, causing a severe, acute form of anemia. Besides being triggered by medications, AIHA can occur in conjunction with other autoimmune diseases, especially systemic lupus erythematosus (SLE), myasthenia gravis, and multiple sclerosis, and it can be triggered by infectious diseases, including human parvovirus B19 infection.

Drug Causes of AIHA

Nearly 100 drugs have long been known to cause autoimmune hemolytic anemia. Offending agents include the anti-malarial compounds such as quinine and chloroquine, anticonvulsant medications such as Dilantin, non-steroidal anti-inflammatory drugs (NSAIDs) such as mefenamic acid and acetaminophen, and the anti-Parkinson’s drug levodopa, For a complete list, see the resource section. In addition to drugs listed, the widely prescribed anti-diabetic agent Metformin and the dietary supplement lecithin have recently been implicated in triggering autoimmune hemolytic anemia.

Illnesses Associated with AIHA

Autoimmune hemolytic anemia is known to occur in patients infected with infectious mononucleosis, cytomegalovirus (CMV), Mycoplasma pneumonia, Epstein-Barr virus (EBV), human immunodeficiency virus (HIV), viral hepatitis, and human parvovirus B-19. AIHA is also known to develop in patients with many different autoimmune diseases such as Sjogren’s syndrome as well as chronic lymphocytic leukemia (CLL), lymphoproliferative disorders, ovarian cancer, and blood cancers such as non-Hodgkin’s lymphoma.


Metformin is a biguanide antidiabetic drug that has been implicated in several cases of hemolytic anemia, including one fatality. In the fatality, metformin caused a rapidly fatal hemolytic anemia in a 56-year-old Caucasian man with type 2 diabetes mellitus who had recently started metformin. Over a course of 4 days, the patient’s condition deteriorated and he did not respond to steroid medications. Twelve hours after admission to the hospital, the patient died of a fatal cardiorespiratory arrest related to a low hemoglobin level.

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The dietary supplement lecithin was found to cause hemolytic anemia in a 38-year old Greek woman using high doses (1200 mg up to 3-4 times daily for 10 days) for weight loss. The authors of this study warn that any drug or supplement patients are taking should be investigated in newly diagnosed cases of AIHA.

The Common Causes Of Lower Back Pain

Of all the ailments that one could possibly encounter over his lifetime, lower back pain would probably account for the majority of the experiences and not to mention the extent of frustration and disruption to one’s everyday life. The back belongs to part of the spine and is a complicated musculoskeletal structure which is made up of a network of different components; disorders or problems in any of the parts of the lower back could propagate and manifest as a syndrome of lower back pain. That is the reason why lower back pain could affect almost up to 80% of the population over their lifetimes.

Despite it being such a common syndrome, a myriad of causes with varying severity could be attributed to its symptoms.  A typical muscular strain could induce an immediate and great deal of pain compared to a more severe situation of spinal disc herniation or degenerative discs where only minor discomfort may be experienced.

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Hence it is crucial that one must describe the symptoms clearly and obtain an accurate diagnosis of the underlying causes before pain relief could be administered. Let us take a look at the different possible types of lower back pain and their respective causes.

Axial Back Pain.

The pain experienced is confined to the lower back region does not extend into the lower body, buttocks or legs. The degree of pain ranges from a mild ache to an acute sting. Daily activities like standing and walking could be restricted under very severe conditions. T

he syndrome tends to be aggravated while performing particular activities such as sports or staying in extended physical positions like sitting in office cubicle. The diagnosis of the causes of axial back pain is not critical as it is not required for treatment. Resting usually brings about relief and the pain is commonly short termed – occurring over a 2-3 months span. However there are cases where axial back pain does not subside fully and becomes a chronic condition.

Chronic lower back pain.

Pain in the lower back that persists for extended duration and which is worsened by particular posture and physical movements. Symptoms include continuous mild pain in with periods of acute aches or muscle spasms which stays from a few days up to months.

The pain could get worse by sitting down or standing upright and frequent adjustment of posture provides relief for the pain. One of the common causes behind this is lumbar degenerative disc disease. This disease affects even young patients in their teens.  As the lumbar discs between the spinal vertebrae starts to degenerate and break down; inflammation occurs which causes instability in the affected region and trigger off a series of painful muscular spasms. Thankfully, this is a common condition and treatments are readily available.

Sciatica or Lumbar radiculopathy.

A condition that causes numbness/weakness on the lower back and asymmetric pain in the lower body region. One side of the lower body could be more severely affected, and the pain could spread to the entire length of the foot starting from the buttocks.

This is caused by musculoskeletal conditions where the nerve roots leading to the sciatic nerve are compressed or irritated. A common condition for this is a ruptured or herniated disc in the spine that exerts pressure against the nerve roots. Treatment includes medication, changing of lifestyle to avoid sitting down for extended periods and switching between lying down and going for walks.