Inclusion Criteria:  Patients aged more than 18 years old from any sex with a diagnosis of primary warm autoimmune hemolytic anemia (AIHA) based on the presence of hemolytic anemia and serological evidence of anti-erythrocyte antibodies, detectable by the direct antiglobulin test who have disease progression or failure after treatment with steroid therapy, or who are intolerant to treatment, or who refuse standard treatment. No evidence of a lymphoproliferative malignancy or other autoimmune-related underlying conditions.  Exclusion Criteria:  any contraindications to the drugs of the study. any identified secondary cause of the AIHA. pregnant or lactating women.