Autoimmune Haemolytic Anaemia — RACP Adult Medicine MCQ

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ModerateHaematologyAutoimmune Haemolytic AnaemiaRACP Adult Medicine

A 35-year-old woman presents with fatigue, jaundice, and dark urine. Her haemoglobin is 68 g/L, reticulocyte count is 12%, haptoglobin is undetectable, LDH is 1200 U/L, and direct Coombs test is positive for IgG. What is the most appropriate first-line treatment?

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Correct answer: A — Prednisolone 1 mg/kg/day

This patient has warm autoimmune haemolytic anaemia (AIHA) confirmed by Coombs-positive haemolysis (IgG-mediated). First-line treatment is prednisolone 1–1.5 mg/kg/day, which produces a response in 70–85% of patients. Rituximab is second-line for refractory or relapsing disease. Splenectomy is third-line. Blood transfusion should not be withheld if haemoglobin is critically low, but compatible blood may be difficult to find.

Reference: eTG – 2025 – Haematology; BSH – 2017 – AIHA Guidelines