Inclusion Criteria:  diagnosis of erythematosus (SLE) according to The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) guidelines. secondary autoimmune hemolytic anemia (AIHA) that does not respond properly to corticosteroid or when the patients are intolerant to treatment, or refuse standard treatment.  Exclusion Criteria:  Pregnant or breastfeeding women. any contraindication of the used drugs. any known hypersensitivity of the used drugs. congenital hemolytic anemia. chronic renal failure.