Hemodynamics, fluids & transfusion
Severe autoimmune hemolytic anemia in intensive care unit (ICU): a place for emergency plasma exchange? A French multicenter retrospective study
Authors' conclusion
In this large ICU cohort, severe AIHA was associated with high mortality, driven by organ failure rather than anemia severity. PlEx are associated with survival, suggesting its potential role as a bridge to immunosuppressive therapy in selected cases.
Study context
- Population
- Patients with severe autoimmune hemolytic anemia (AIHA) admitted to 15 ICUs of the AP-HP network, 2017–2024
- Participants
- 148 ICU stays
- Exposure
- Plasma exchange vs no plasma exchange (PlEx)
- Outcome
- In-ICU mortality (predictors; association with PlEx)
Methodological detailsmulticentre, propensity-score adjusted, inverse probability of treatment weighting
- Multicentre
- Propensity-score adjusted
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
In-ICU mortality
PlEx vs No PlExOdds ratio (CI)P value
Multivariate logistic regression; associated with improved survival
0.04(0.004–0.4)
P = 0.008PS adjustment
0.04(0.001–0.39)
P = 0.012IPTW adjustment
0.13(0.02–0.55)
P = 0.011- Overall in-ICU mortality
- 17.6%
Observational data: associations, not effects.
Further findings
In-ICU mortality with standard corticosteroid therapy (1-2 mg/kg)
| OR (CI) | P value | ||
|---|---|---|---|
| Standard corticosteroid therapyAssociated with improved survival | 0.19 (0.03–0.94) | P = 0.05 | |
| 0.050.21520Odds ratio (log scale) |
Risk factors for in-ICU mortality
- Age > 60 years, RRT, mechanical ventilation and high-dose IV methylprednisolone (high-dose intravenous methylprednisolone (HDIM)); mortality mainly driven by organ dysfunction rather than anemia severity
Baseline characteristics
- Median age at ICU admission, years {range as printed}
- 61 {48-71}
- Male
- 51%
- Admission median hemoglobin, g/dL
- 5.2 {4.2-7.2}
Original publication
Severe autoimmune hemolytic anemia in ICU: a place for emergency plasma exchange? A French multicenter retrospective study. Crit Care. Published 30 September 2025. doi:10.
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