A 35-year-old man has autoimmune haemolytic anaemia (AIHA) with Hb 7.2 g/dL, reticulocytosis, positive direct antiglobulin test (DAT/Coombs) with IgG warm antibody. He has failed prednisolone 1 mg/kg for 6 weeks (Hb stable at 7–7.5 g/dL). According to current ASH 2021 AIHA guidelines, the recommended second-line therapy is:
- A Cyclosporine
- B Rituximab (anti-CD20) 375 mg/m² weekly for 4 doses ✓
- C Splenectomy immediately
- D Mycophenolate mofetil
Explanation
ASH 2021 guidelines for warm AIHA recommend rituximab as the preferred second-line therapy after corticosteroid failure or relapse, based on multiple retrospective studies and a randomised trial (RAIHA) showing response rates of 70–80% in steroid-refractory warm AIHA. Rituximab depletes CD20+ B-cells, reducing autoantibody production. Splenectomy remains an option, particularly for relapsed/refractory disease, but rituximab is now preferred before surgery given comparable efficacy and avoidance of surgical risks. MMF and azathioprine are used as steroid-sparing maintenance agents.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.