ARTICLE: Warm Autoimmune Hemolytic Anemia

AUTHORS: Robert A. Brodsky

JOURNAL: N Engl J Med. 2019 Aug 15;381(7):647-654. doi: 10.1056/NEJMcp1900554.

A 61-year-old woman presents to the emergency department reporting fatigue, increasing dyspnea, and dark urine. The respiratory rate is 30 breaths per minute, the pulse 116 beats per minute, and the oxygen saturation 90% while she is breathing ambient air. She is pale, without splenomegaly or adenopathy. Her hemoglobin level is 5.4 g per deciliter, hematocrit 16.1%, and mean corpuscular volume 103 fl; the white-cell and platelet counts are normal. The percentage of reticulocytes is 15.7%, and the total bilirubin level is 9.7 mg per deciliter (166 μmol per liter). A peripheral-blood smear reveals numerous microspherocytes. A direct antiglobulin test is positive for IgG and weakly positive for C3d. Laboratory tests show a panagglutinin. She takes no regular medication. How would you further evaluate and treat this patient?

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