A 65-year-old man with known chronic lymphocytic leukemia presents with worsening fatigue and jaundice. Hemoglobin drops from 11 to 7 g/dL. Reticulocyte count is elevated, haptoglobin is low, and the direct antiglobulin test is positive. What is the most likely complication?
- A Microangiopathic hemolytic anemia
- B Autoimmune hemolytic anemia ✓
- C Pure red cell aplasia
- D Myelodysplastic syndrome
Correct answer: B. Autoimmune hemolytic anemia
Explanation
CLL is frequently associated with autoimmune complications, most commonly autoimmune hemolytic anemia. The direct antiglobulin test is positive in warm AIHA, which is typical in CLL. Microangiopathic hemolysis would show schistocytes. Pure red cell aplasia presents with anemia and absent reticulocytes without hemolysis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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