Haematology: warm autoimmune haemolytic anaemia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: warm autoimmune haemolytic anaemia

Sample item

A 40-year-old woman with systemic lupus erythematosus has fatigue and jaundice. Haemoglobin is 6.8 g/dL, reticulocytes are 12%, the film shows spherocytes, and the direct antiglobulin test is positive for IgG at 37 degrees Celsius. What is the most appropriate first-line treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Oral prednisolone

Warm autoimmune haemolytic anaemia is mediated by IgG autoantibodies that coat red cells, which are then partly phagocytosed in the spleen as spherocytes. Corticosteroids are first line, with rituximab or splenectomy for steroid failure or relapse. Associations include lymphoproliferative disease and SLE.

Option by option

  • A. Oral prednisolone (correct)

    Corticosteroids suppress antibody production and clearance, and they are first-line.

  • B. Immediate splenectomy

    Splenectomy is reserved for refractory or relapsing disease after steroids.

  • C. Avoidance of cold exposure alone

    Cold avoidance is the measure for cold agglutinin disease, caused by IgM, not for warm IgG disease.

  • D. Oral iron supplementation

    Iron is not indicated because the problem is extravascular haemolysis and not iron deficiency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Oral prednisolone. Warm autoimmune haemolytic anaemia is mediated by IgG autoantibodies that coat red cells, which are then partly phagocytosed in the spleen as spherocytes.

Why is "Immediate splenectomy" not the answer?

Splenectomy is reserved for refractory or relapsing disease after steroids.

Why is "Avoidance of cold exposure alone" not the answer?

Cold avoidance is the measure for cold agglutinin disease, caused by IgM, not for warm IgG disease.

Why is "Oral iron supplementation" not the answer?

Iron is not indicated because the problem is extravascular haemolysis and not iron deficiency.

What concept does this question test?

It tests Haematology: warm autoimmune haemolytic anaemia in Pathology. Corticosteroids are first line, with rituximab or splenectomy for steroid failure or relapse. Associations include lymphoproliferative disease and SLE.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: warm autoimmune haemolytic anaemia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.