A 67-year-old woman has dyspnoea, jaundice and chest pain. Haemoglobin is 49 g/L, reticulocytes and bilirubin are raised, haptoglobin is undetectable

Question

A 67-year-old woman has dyspnoea, jaundice and chest pain. Haemoglobin is 49 g/L, reticulocytes and bilirubin are raised, haptoglobin is undetectable and the direct antiglobulin test is IgG-positive. Crossmatching is delayed by a pan-reacting warm autoantibody. What is the best immediate plan?

Accepted Answer

Start prednisolone and transfuse suitably matched blood for life-threatening anaemia

Answer

Defer transfusion until a fully compatible red-cell unit becomes available

Answer

Perform emergency splenectomy before commencing corticosteroid or transfusion treatment

Answer

Give rituximab alone and reassess haemoglobin after its first infusion

Answer

Use a blood warmer as sole therapy because the antibody is temperature-dependent

Warm autoimmune haemolytic anaemia — SCE Acute Medicine MCQ

A 67-year-old woman has dyspnoea, jaundice and chest pain. Haemoglobin is 49 g/L, reticulocytes and bilirubin are raised, haptoglobin is undetectable and the direct antiglobulin test is IgG-positive. Crossmatching is delayed by a pan-reacting warm autoantibody. What is the best immediate plan?