Haematology: warm autoimmune haemolytic anaemia: practice question

A General Medicine 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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General Medicine · Haematology: warm autoimmune haemolytic anaemia

Sample item

A 45-year-old woman with systemic lupus erythematosus has fatigue and jaundice. Haemoglobin is 6.8 g/dL, reticulocytes 12%, LDH is raised, the film shows spherocytes and the direct Coombs test is positive for IgG. What is the first-line treatment?

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

The answer and the reasoning

D. Oral prednisolone

Warm autoimmune haemolytic anaemia is caused by IgG autoantibodies coating red cells, which are removed by splenic macrophages. Glucocorticoids (prednisolone about 1 mg/kg) are first-line and work in most patients. Rituximab is the usual second-line, with splenectomy later, and folic acid is given to support increased marrow turnover.

Option by option

  • A. Splenectomy

    Splenectomy is a later option for steroid failure or relapse.

  • B. Plasma exchange

    Plasma exchange is used for TTP and has little role in warm haemolysis.

  • C. Intravenous iron

    Iron is not needed in haemolysis and can worsen overload.

  • D. Oral prednisolone (correct)

    Correct. Steroids suppress autoantibody production and red cell clearance.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Oral prednisolone. Warm autoimmune haemolytic anaemia is caused by IgG autoantibodies coating red cells, which are removed by splenic macrophages.

Why is "Splenectomy" not the answer?

Splenectomy is a later option for steroid failure or relapse.

Why is "Plasma exchange" not the answer?

Plasma exchange is used for TTP and has little role in warm haemolysis.

Why is "Intravenous iron" not the answer?

Iron is not needed in haemolysis and can worsen overload.

What concept does this question test?

It tests Haematology: warm autoimmune haemolytic anaemia in General Medicine. Glucocorticoids (prednisolone about 1 mg/kg) are first-line and work in most patients. Rituximab is the usual second-line, with splenectomy later, and folic acid is given to support increased marrow turnover.

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?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.