American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for warm autoimmune hemolytic anemia?

1. Rituximab

2. Glucocorticoids

3. Splenectomy

4. Transfusion of red blood cells

The correct answer is: Glucocorticoids

For warm autoimmune hemolytic anemia (AIHA), the first-line treatment is glucocorticoids. This approach is effective because glucocorticoids work by suppressing the immune system, specifically reducing the production of antibodies that are responsible for the destruction of red blood cells. They lead to a decrease in hemolysis, increasing the lifespan of red blood cells and helping to improve anemia symptoms in patients. Other treatments, while also used in specific scenarios, are not the first-line option. Rituximab, a monoclonal antibody that targets B cells, is generally considered for patients who are refractory to glucocorticoid treatment or in more severe or chronic cases. Splenectomy may be considered in certain patients with persistent or recurrent hemolysis, especially when there is a confirmed role of the spleen in the process, but this is usually not the initial step in management. Transfusion of red blood cells can be performed for acute management of severe anemia but does not address the underlying immune process and is not a long-term solution. Thus, glucocorticoids are the preferred initial therapeutic strategy for managing warm autoimmune hemolytic anemia due to their direct action on the immune system to reduce hemolysis.