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N. Mariana S. Vasquez: Warm vs Cold Autoimmune Hemolytic Anemia for USMLE/NBME Questions
N. Mariana S. Vasquez/X
Sep 5, 2026, 02:28

N. Mariana S. Vasquez: Warm vs Cold Autoimmune Hemolytic Anemia for USMLE/NBME Questions

N. Mariana S. Vasquez, IMG Physician, shared a post on X:

“Warm vs Cold Autoimmune Hemolytic Anemia

The easiest way to separate them on USMLE/NBME questions:

Warm AIHA

  • IgG – reacts at body temperature
  • Extravascular hemolysis in the spleen
  • Spherocytes
  • Positive direct Coombs test for IgG

Classic associations: SLE, CLL, methyldopa

Cold agglutinin disease

  • IgM – reacts in cold temperatures – Complement activation – hemolysis – RBC agglutination
  • Positive direct Coombs test for C3

Classic associations: Mycoplasma pneumoniae, EBV, lymphoproliferative disorders

USMLE / NBME shortcut

Warm – IgG – Spleen – Spherocytes

Cold – IgM – Complement – Agglutination

Clinical clue: Patient with pneumonia develops acrocyanosis/Raynaud-like symptoms and hemolysis

Think cold agglutinin disease.”

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