Management of Primary WARM AIHA

File Name: Management-of-Primary-WARM-AIHA.pdf

Some important points:-

  1. PRBC transfusion in Primary Warm AIHA is done only if: HB < 5 g/dl or there is life threatening anemia at presentation.
  2. Clinical judgment is most critical at a hemoglobin level of 5 to 8 g/dL. At this range of hemoglobin, many patients with AIHA should be transfused unless close observation indicates that the anemia is not becoming progressively more severe and the patient has no critical symptoms of anemia.
  3. If anemia is life threatening, transfusion with ABO, Rh and K matched blood is more appropriate than delaying until full serological investigations have been completed. In limited setting ABO and RhD matched unit can also be transfused. Consider giving Methylpred (3-4 mg/kg) prior to transfusion.
  4. Adequate testing for alloantibodies, as described above, in a patient with AIHA may take 4 to 6 hours, or even longer.
  5. Approx 80% patients respond to corticosteroids (as first line treatment) at a dose equivalent to prednisolone 60–100 mg/day and approximately 50-60 % achieve complete remission.
  6. Thorough Exclusion of Secondary causes is important before thinking of 2nd Line treatment.

Leave a Reply