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Warm AIHA — RACP Adult Medicine MCQ

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EasyHaematologyWarm AIHARACP Adult Medicine

A 28-year-old woman presents with fatigue, jaundice, and dark urine. Hb is 65 g/L, reticulocytes 15%, LDH elevated, haptoglobin undetectable, and direct Coombs test (DAT) is positive for IgG. Blood film shows spherocytes and polychromasia. What is the most likely diagnosis?

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Correct answer: D — Warm autoimmune haemolytic anaemia

Haemolytic anaemia (elevated LDH, low haptoglobin, reticulocytosis) with positive DAT for IgG and spherocytes is diagnostic of warm AIHA. Warm AIHA is mediated by IgG antibodies causing extravascular haemolysis (predominantly splenic). First-line treatment is prednisolone 1 mg/kg. Second-line options include rituximab, mycophenolate, or splenectomy.

Reference: BSH – 2024 – AIHA Guidelines; eTG Haematology 2024