Retrospective analysis of 26 children with severe autoimmune hemolytic anemia treated with transfusions of red blood cells.

Autoimmune hemolytic anemia (AIHA) is rare inchildren. Little is known about the efficiency of red blood cells (RBCs) transfusions and the risk of reactions among children with severe AIHA. This article describes the clinical features and outcomes in AIHA children after RBCs transfusions. A retrospective study was conducted among hospitalized AIHA children from July 2019 to October 2024 in a tertiarycare medical center in China. Twenty-six patients received 47 RBCs transfusions, with a median age at diagnosis of 59.5 months. Sixteen patients had secondary AIHA, with 8 systemic lupus erythematosus patients. Only 7 RBCs transfusions were compatible with both major and minor cross-matching. After transfusions, the median hemoglobin levels increased from 43 to 67 g/L. All patients were treated with steroids and 24 patients were treated with intravenous immunoglobulin before RBCs transfusions. No adverse reaction was observed. The median follow-up period was 39 months and the median steroid duration was 14 months. Nine patients experienced relapses after reducing steroid dosage. In conclusion, systemic lupus erythematosus is the main causes of secondary severe AIHA in children. Blood transfusions after steroids and intravenous immunoglobulin, even with incompatible RBCs, are safe and efficient for for children with severe AIHA.