For the management of warm autoimmune hemolytic anemia, what should be done if glucocorticoids are ineffective?

In cases of warm autoimmune hemolytic anemia (AIHA), when glucocorticoids prove ineffective, considering a splenectomy is a well-recognized next step in management. The spleen plays a significant role in the destruction of red blood cells, particularly in autoimmune processes where antibodies target these cells. By surgically removing the spleen, one can reduce the destruction of red blood cells and often leads to an improvement in hemolysis and overall anemia.

Splenectomy is especially considered in chronic cases where patients may not respond adequately to medical therapy, including corticosteroids. This intervention can provide a curative effect in many patients as the spleen is a critical site of antibody-mediated hemolysis. Overall, the choice to consider splenectomy is based on its potential to address the underlying pathology of the autoimmune hemolysis when alternative therapeutic approaches, like increasing steroid doses, are insufficient or lead to adverse effects without addressing the root cause effectively.