What management strategies are recommended for patients with confirmed autoimmune haemolytic anaemia?

Management strategies for autoimmune haemolytic anaemia (AIHA) focus on controlling haemolysis, treating underlying causes, and preventing complications. Initial treatment typically involves corticosteroids, such as prednisolone, to reduce immune-mediated red cell destruction and achieve remission NICE NG239 Jäger et al. 2020. If patients are refractory or relapse after steroids, second-line therapies include immunosuppressive agents like rituximab, which targets B cells responsible for autoantibody production, or other immunosuppressants such as azathioprine or cyclophosphamide NICE NG239 Kamesaki 2019. In severe or life-threatening cases, blood transfusions may be necessary but should be used cautiously due to alloimmunisation risk and difficulty in cross-matching NICE NG239 Jäger et al. 2020. Splenectomy is considered in chronic or refractory AIHA, especially when medical therapy fails, as the spleen is a major site of red cell destruction and antibody production NICE NG239 Autore et al. 2021. Supportive care includes folic acid supplementation to support erythropoiesis and monitoring for complications such as thrombosis, which is increased in AIHA NICE NG239 Jäger et al. 2020. Treating any underlying conditions, such as lymphoproliferative disorders or infections, is essential for secondary AIHA management Autore et al. 2021. Recent literature emphasizes the role of novel targeted therapies and individualized treatment plans based on AIHA subtype and patient response, but corticosteroids remain the cornerstone of initial management NICE NG239 Kamesaki 2019Jäger et al. 2020.