Q. I want to know about the relapse regarding AIHA.

Hi,

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Approximately 80 % of patients respond to corticosteroids at a dose equivalent to Prednisolone 60 to 100 mg per day and nearly two-thirds achieve complete remission (CR). The initial response takes several weeks. But an absence of a response for 21 days is considered as a steroid failure. In responding patients, an incremental taper can begin, for example, when the Hb (hemoglobin) is more than 100 g/dL or after a maximum of three weeks, we can reduce the dose to 20 to 30 mg over four to six weeks, and then by 5 mg every month.

In a series of 33 primary AIHA (autoimmune hemolytic anemia) cases, relapse was more common if the steroids were tapered to 10 mg in less than two months and when stopped in less than six months. Approximately 20 % of patients remain in remission after steroids are discontinued. Although a further 40 % can maintain an acceptable Hb by keeping Prednisolone at 15 to 20 mg, due to the long-term side effects of steroids, and a second-line therapy is considered.

Dr. Girish C Kamat

Hematology

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