Ryan O’Keefe: Recognizing Warm AIHA From Hemolysis and a Positive DAT
Ryan O’Keefe, Internal Medicine Resident at the Hospital of The University of Pennsylvania, Creator of Point of Care Medicine, shared a post on X:
“Daily Pearl(s):
Warm Autoimmune Hemolytic Anemia (AIHA)
In warm AIHA, IgG antibodies bind to the surface of RBCs, which are then destroyed by macrophages in the spleen and liver via extravascular hemolysis.
Sepsis can be a non-malignant trigger of warm AIHA.
A rapid drop in Hgb with evidence of hemolysis (high LDH, low hapto) and a positive DAT is concerning for warm AIHA.
The presence of many nucleated RBCs (NRBCs) indicates bone marrow stress. NRBCs might be mistaken for WBCs by automated counters. This may inappropriately lead to concern for a leukemoid reaction.
Cephalosporins like CTX and cefepime are common causes of drug-induced immune hemolytic anemia.
Source: CPS – May 26, 2026 VMR with Ravi and Kirtan – new onset anemia.
Learn more clinical pearls from the Point of Care Medicine Substack!”
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