BTK inhibitors (rilzabrutinib) — inhibit B-cell activation and autoantibody production
Trials ongoing in warm AIHA
Patient Discharge Instructions
copy discharge instructions
What is autoimmune hemolytic anemia
Your immune system is making antibodies that destroy your own red blood cells
This leads to anemia (low red blood cell count) and may cause fatigue, shortness of breath, and pale or yellow skin
It can be a chronic condition that requires ongoing treatment and monitoring
Your medications
Take prednisone exactly as prescribed — do not stop suddenly
This medication suppresses your immune system to stop red blood cell destruction
Take with food to reduce stomach upset
Take folic acid 1 mg daily to support new red blood cell production
Continue all other prescribed medications unless told otherwise
Diet and lifestyle
Stay well hydrated — drink 6–8 glasses of water daily
Avoid alcohol while on prednisone
If you have cold-type AIHA: avoid cold temperatures
Wear warm gloves and clothing outdoors in cold weather
Avoid cold drinks and ensure IV fluids are warmed at hospital
Follow-up schedule
Hematology appointment within 1–2 weeks of discharge
Blood tests (CBC, LDH, haptoglobin, bilirubin) required at each visit
Do not miss follow-up — blood counts can change rapidly
Return to emergency department immediately for
Severe shortness of breath or chest pain
Sudden onset or worsening — may indicate dangerous drop in hemoglobin or blood clot
Dark or cola-colored urine
Indicates active red blood cell destruction (hemolysis)
High fever or signs of infection
Prednisone increases infection risk; even mild infections require urgent evaluation
Worsening fatigue, dizziness, or fainting
Signs that anemia is worsening
New leg swelling, calf pain, or sudden shortness of breath
Signs of blood clot (DVT or pulmonary embolism) — risk is elevated in AIHA
New bruising, pinpoint red spots (petechiae), or unusual bleeding
May indicate Evans syndrome (combined low platelets and hemolytic anemia)
Steroid side effects to monitor
Blood sugar elevation — especially if diabetic; monitor glucose more frequently
Weight gain and fluid retention
Mood changes or difficulty sleeping
Bone thinning with prolonged use — calcium and vitamin D may be prescribed
Do not take NSAIDs (ibuprofen, naproxen) with prednisone without physician approval
References
Guidelines and key sources
Michel M, Crickx E, Fattizzo B, Barcellini W
Autoimmune Haemolytic Anaemias
Nature Reviews Disease Primers 2024
PMID 39487134
Barcellini W, Fattizzo B
Management of Autoimmune Hemolytic Anemia
Hematology ASH Education Program 2025
PMID 41347987
Brodsky RA
Warm Autoimmune Hemolytic Anemia
New England Journal of Medicine 2019
DOI 10.1056/NEJMcp1900554
Berentsen S, Barcellini W
Autoimmune Hemolytic Anemias
New England Journal of Medicine 2021
DOI 10.1056/NEJMra2033982
Liu AP, Cheuk DK
Disease-Modifying Treatments for Primary Autoimmune Haemolytic Anaemia
Cochrane Database of Systematic Reviews 2021
DOI 10.1002/14651858.CD012493.pub2
Fattizzo B, Marchetti M, Michel M et al
Diagnosis and Management of Evans Syndrome in Adults: First Consensus Recommendations
Lancet Haematology 2024
PMID 38968944
Zhao X, Sun J, Zhang Z et al
Sovleplenib in Patients With Primary or Secondary Warm Autoimmune Haemolytic Anaemia
Lancet Haematology 2025
PMID 39799953
Barcellini W, Fattizzo B
Autoimmune Hemolytic Anemia: New Frontiers in Diagnosis and Therapy
Blood Reviews 2026
PMID 41813558
Phillips J, Henderson AC
Hemolytic Anemia: Evaluation and Differential Diagnosis
American Family Physician 2018
PMID 30215915
Jones DE, Walker JJ, Abellada AMP
Hematologic Emergencies: Recognition and Initial Management
American Family Physician 2024
PMID 39028783
NCCN Guidelines
Management of Immune Checkpoint Inhibitor-Related Toxicities
Updated 2025; includes checkpoint inhibitor-induced AIHA
National Comprehensive Cancer Network
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.