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  • Title: [Treatment of autoimmune hemolytic anemias in children].
    Author: Leverger G, Bancillon A, Schaison G.
    Journal: Ann Pediatr (Paris); 1989 Oct; 36(8):519-23. PubMed ID: 2683950.
    Abstract:
    Management of autoimmune hemolytic anemias (AIHA) in children is often difficult as some patients are very young and the course is often unpredictable. Corticosteroid therapy is the mainstay of the treatment of AIHAs. A dose of 2mg/kg/d should be given as early as possible. The return to normal of hemoglobin levels and reticulocyte counts are the two chief criteria of effectiveness. Only when both are present can disease remission be affirmed and corticosteroid therapy phased out over several months. Inadequate therapy of an acute form may promote prolongation of the disease. Prior to blood transfusion, the following tests should be performed: determination of ABO and Rh groups, determination of the erythrocyte phenotype whenever possible, identification of the specificity of the autoantibody, and investigations for an alloantibody. Splenectomy and immunosuppressive treatments are very rarely used and are indicated only in chronic forms of more than three months duration that fail to respond to high dose corticosteroid therapy or relapse as soon as doses are reduced. On the opposite, some forms are hyperacute and resolve very rapidly, with negativation of the often complement-type Coombs test; the course may be self-limited, especially if the autoantibody is a cold agglutinin or a biphasic hemolysin (Donath Landsteiner type), requiring no more than a few weeks of corticosteroid treatment.
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