इवान्स सिंड्रोम का प्रथम-पंक्ति उपचार क्या है?

References

1. Corticosteroids remain the cornerstone of first-line treatment — predniso(lo)ne at the initial daily dose of 1 mg/kg is the standard of care.
2. The efficacy of repeated courses of dexamethasone toward predniso(lo)ne has not been specifically tested in ES, but based on the data available in ITP, it can be viewed as a relevant alternative.
3. In case of severe bleeding manifestations, the use of IVIg at a dose of 1 to 2 g/kg in combination with corticosteroids is required to avoid a life-threatening hemorrhage, whereas IVIg has only a little efficacy for the management of severe wAIHA.
4. For patients with severe wAIHA, transfusion of packed RBCs must not be postponed, and the transient use of recombinant erythropoietin may be useful for those patients with severe wAIHA and an inadequate reticulocytosis.
5. Predniso(lo)ne is usually maintained at the initial dose for 3 weeks followed by progressive weaning over at least 3 months as usually recommended for adult wAIHA.
6. For patients not responding to predniso(lo)ne, the daily dose can be transiently increased up to a maximum of 2 mg/kg, although the efficacy of such a dose has never been fully demonstrated.
7. In the absence of initial response (≈20% of the patients), or in case of corticosteroid-dependency with the need of maintaining a daily dose of predniso(lo)ne of more than 10 mg to maintain at least a partial response (i.e., a platelet count ≥30 × 10&sup9;/L with at least a doubling of the initial count and/or a Hb level ≥10 g/dL with at least a 2 g increase from baseline), a second-line therapy is needed.
8. Complete response — haemoglobin level greater than 12 g/dL without ongoing haemolysis and platelet count ≥100 × 10&sup9;/L.