Drug-induced immune haemolytic anaemia (DIIHA) typically begins to improve after the offending agent is withdrawn and folic acid supplementation is started. When that first-line step does not achieve haematological improvement within the expected window — or when the presentation is acutely severe from the outset — escalated management is required.
First-line management centres on discontinuing the suspected drug and adding folic acid. The target is resolution of haemolysis, usually within 1–2 weeks of stopping the drug. When haematological improvement does not occur in that timeframe, or when the patient presents with acute severe haemolysis, the next protocol step is indicated.
Acute severe DIIHA is managed in an intensive care environment. Immediate priorities include securing intravenous access, fluid resuscitation, and close monitoring of haemodynamic status, renal function, and haemoglobin. In cases of life-threatening anaemia, red-cell transfusion is used. Further interventions are determined individually based on clinical severity and the certainty of the drug-induced aetiology. The complete structured protocol — including all decision points — is available via the link below.