0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
816 Immune Hemolytic Anemiabe transfused with red blood cells that lack the corresponding
antigen
■transfusions in life-threatening situations (severe anemia with
hemoglobin <7 g/dl) with high-output cardiac failure or cerebral
compromise should never be delayed
■CAHA
■supportive care; avoidance of cold temperatures to prevent recur-
rent attacks; transfuse red blood cells for life-threatening anemia;
transfusing through a blood warmer is advocated.
■PCH
■supportive care for most post-infectious cases; avoidance of cold
temperatures to prevent recurrent attacks; transfuse red blood cells
for life-threatening anemia; transfusing through a blood warmer is
advocated.
■MTHA
■blood transfusions should adhere to guidelines outlined earlier for
WAHA; transfusing through a blood warmer is advocated.
■DIHA
■supportive care; transfuse red blood cells for clinically significant
anemia; attempt to identify and withdraw offending medication
specific therapy
Indications
■Severe hemolysis and life-threatening anemia; acrocyanosis
Treatment Options
■WAHA
➣Steroids
primary therapy; acutely diminish extravascular hemolysis by
blocking macrophage Fc receptor activity; inhibit antibody
production
prednisone 1 to 2 mg/kg/day PO until hemoglobin levels stabi-
lize then gradually taper at a rate of 5 to 10 mg per week; some
patients may require a more gradual tapering schedule.
methylprednisolone 2 to 4 mg/kg/day IV in divided doses for
critically ill patients
➣Splenectomy
steroid-refractory patients or patients requiring unacceptably
high (>15 mg/day) doses of prednisone to maintain remission
➣Azathioprine
1.5 mg/kg/day PO for patients unfit for surgery or patients
who failed steroids and splenectomy; should not be used for
extended periods due to side effects.