A 42-year-old woman presents with jaundice and dark urine. Hemoglobin is 7.8 g/dL, reticulocyte count 12%, and the smear shows numerous spherocytes. Direct Coombs test is positive for IgG and C3d. The most appropriate first-line therapy is:

• A Oral corticosteroids ✓
• B Rituximab
• C Splenectomy
• D Iron supplementation

Explanation

This is warm antibody autoimmune hemolytic anemia: IgG-coated spherocytes removed extravascularly by splenic macrophages. Corticosteroids are the established first-line agent because they reduce macrophage Fc receptor expression and decrease antibody production. Splenectomy is reserved for steroid-refractory or relapsing disease, and rituximab is second line. Iron would be harmful since this is a hemolytic, not iron-deficient, state. Cold agglutinin disease responds poorly to steroids, but the IgG positivity and spherocytes confirm the warm type here.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.