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How can autoimmune hemolytic anaemia be treated?

Q: My 57 years old mother has been diagnosed with autoimmune hemolytic anaemia. She is on steroids and because of this her haemoglobin level has increased from 3.6 to 10.1. How long will she need to take steroids? How can she be treated?

A:Autoimmune hemolytic anaemia (AIHA) is a type of hemolytic anaemia where the body's immune system attacks its own red blood cells (RBCs), leading to their destruction (hemolysis). If symptoms are mild or if destruction of red blood cells seems to be slowing on its own, no treatment is needed. If red blood cell destruction is increasing, a corticosteroid such as prednisone is usually the first choice for treatment. High doses are used at first, followed by a gradual reduction of the dose over many weeks or months. When people do not respond to corticosteroids or when the corticosteroid causes intolerable side effects, surgery to remove the spleen (splenectomy) is often the next treatment. The spleen is removed because it is one of the places where antibody-coated red blood cells are destroyed. When destruction of red blood cells persists after removal of the spleen or when surgery cannot be done, immunosuppressive drugs, such as cyclophosphamide or azathioprine are used. When red blood cell destruction is severe, blood transfusions are sometimes needed, but they do not treat the cause of the anaemia and provide only temporary relief.


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