We were reviewing the marrow smear from an elderly gentleman with weight loss and macrocytic anaemia. Further results include:

• Reticulocyte count 276×10*9/L
• Bilirubin 54ug/L
• LDH 1056U/L
• DAT IgG 4+

The above is consistent with warm autoimmune haemolytic anemia. The bone marrow showed these features:

This is consistent with erythrophagocytosis, which can be seen in haemolytic anaemia.

Questions:

• What are the causes of warm haemolytic anaemia?
• Any further investigations on the patient’s bone marrow?
• Any further investigations in the peripheral blood?
• What would be first line treatment for warm AIHA?

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