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CLL-Associated AIHA — RACP Adult Medicine MCQ

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ModerateHaematologyCLL-Associated AIHARACP Adult Medicine

A 70-year-old man with known chronic lymphocytic leukaemia (Rai stage III) develops progressive fatigue. His Hb drops from 110 to 65 g/L over 4 weeks. Reticulocyte count is 18%. Direct Coombs test is positive (IgG). LDH is elevated and haptoglobin is low. What complication has developed?

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Correct answer: C — Pure red cell aplasia

CLL is frequently complicated by autoimmune cytopaenias, with autoimmune haemolytic anaemia (AIHA) being the most common (5–10% of CLL patients). Positive DAT (IgG), elevated reticulocyte count, high LDH, and low haptoglobin confirm warm AIHA. Treatment includes corticosteroids (first-line) and rituximab for refractory cases. CLL-directed therapy may also be needed if AIHA is driven by active CLL. Transfusion should not be withheld for life-threatening anaemia despite difficulty crossmatching.

Reference: eTG – 2025 – Haematology; iwCLL – 2018 – CLL Complication Management