Corticosteroid in Autoimmune Hemolytic Anemia

• Corticosteroid in autoimmune hemolytic anemia can stop an immune system from, or limit its ability to, make antibodies (proteins) against red blood cells.
• There is a few available regimens recommended for corticosteroid dosing administration.

Journal of the European Hematology Association :

  Prednisolone

•  Initial dose of 1.0–1.5 mg/kg/day for 1–3 weeks until hemoglobin levels greater than 10 g/dL are reached
•  If none or minimal improvement is observed in the third week, this therapy is assumed to be ineffective
•  After stabilization of hemoglobin, prednisone should be gradually and slowly tapered off at 10–15 mg weekly to a daily dose of 20–30 mg, then by 5 mg every 1–2 weeks until a dose of 15 mg, and subsequently by 2.5 mg every two weeks with the aim of withdrawing the drug

Methylprednisolone

• Intravenous methylprednisolone at 100–200 mg/day for 10–14 days or 250–1000 mg/day for 1–3 days

Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria:

Prednisolone

• Initial  dose of 1 mg/kg/d prednisolone is administered until a hematocrit of greater than 30% or a hemoglobin level greater than 10 g/dL (thus, not necessarily a complete normalization of hemoglobin is reached)
•  If this goal is not achieved within 3 weeks, second-line treatment is started because further improvement with steroid treatment is unlikely
• Once the treatment goal is achieved, the dose of prednisolone is reduced to 20 to 30 mg/d within a few weeks
• Thereafter, the prednisolone dose is tapered slowly (by 2.5-5 mg/d per month)
•  An alternate-day regimen by reducing the dose gradually to nil on alternate days may reduce the side effects of steroids

Netherlands the Journal of Medicine:

Prednisolone

• 1 mg/kg/day is started, and depending on the clinical response is tapered slowly
•  After stabilisation of the haemoglobin a scheme frequently used at our department is to taper prednisolone to a dosage to 20 mg/day in two weeks
• If the haemoglobin level remains stable, dosage can further be reduced to 10 mg/day after a month
• Thereafter, the steroid dosage can further be tapered and be stopped after two weeks

Uptodate:

Prednisolone

• The recommended initial doses are quite high - 1 to 1.5 mg/kg per day of prednisolone 
• Doses in children are generally similar
• A successful treatment manifest by a rising hemoglobin concentration, is usually seen within one to three weeks
• Once remission has been achieved, the steroid dose must be tapered.
• In children, this can be done quite rapidly since the disease process is often self-limited. In adults, tapering should be more gradual in an attempt to find the lowest dose that will maintain an adequate remission
• The following tapering down schedule is found to be useful:

References

1. Netherlands the Journal of Medicine. ‘Autoimmune haemolytic anaemia – A practical guide to cope with a diagnostic and therapeutic challenge. Retrieved from http://www.njmonline.nl/getpdf.php?id=1045
2. Official Journal of the European Hematology Association. ‘Treatment of autoimmune hemolytic anemias’.Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181250/
3. Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.’ How I treat autoimmune hemolytic anemias in adults’. Retrieved from http://www.bloodjournal.org/content/bloodjournal/116/11/1831.full.pdf?sso-checked=true
4. Uptodate. 'Warm autoimmune hemolytic anemia: Treatment'. Retrieved from https://www.uptodate.com.ezp.imu.edu.my/contents/warm-autoimmune-hemolytic-anemia-treatment