How would you approach a patient with newly diagnosed lupus/lupus nephritis receiving cyclophosphamide (euro lupus protocol) with active hemolysis not responding to steroids or IVIG?

Most importantly, the cause of the hemolysis must be figured out. I'd consider the following and order the following tests for each. The treatment varies depending on the cause:

1. Autoimmune hemolytic anemia (AIHA) from SLE: assess the peripheral smear looking for spherocytes and measure direct Coomb...