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Immune-Mediated Hemolytic Anemia: Learning Objectives

Medical Importance

Immune hemolytic anemias can occur as isolated conditions or in association with a variety of systemic illnesses (particularly rheumatic conditions, infections, and various neoplasms), or can be induced by certain medications. These conditions can produce life-threatening anemia; prompt diagnosis and treatment are essential.


  1. Describe the pathophysiology and site of red blood cell destruction of immune-mediated hemolysis due to IgG, IgM, and complement.
  2. Describe the procedures involved in performing a direct antiglobulin test (direct Coombs test) and an indirect antiglobulin test (indirect Coombs test).
  3. List mechanisms by which drugs induce immune hemolytic anemia.
  4. Distinguish warm antibody-induced autoimmune hemolytic anemia from cold antibody-induced autoimmune hemolytic anemia on the basis of:
    • Immunoglobulin class of the antibody
    • Presence of red blood cell agglutination
    • Direct antiglobulin test results
    • Clinical manifestations