Three Faces of Self-Destruction: A Case Series of Warm, Cold, and Mixed Autoimmune Hemolytic Anemia

Autoimmune hemolytic anemia (AIHA) is an immune-mediated disorder in which red blood cells are destroyed by autoantibodies. It is classified as warm, cold, or mixed depending on the type of antibody involved. The clinical presentation can range from mild anemia to severe hemolysis, and it may occur as a primary condition or secondary to infections, autoimmune disorders, or hematological malignancies. Diagnosis relies on clinical findings combined with immunohematological tests, specifically the direct antiglobulin test (DAT). We describe the cases of three patients with different types of AIHA. The first patient was a 58-year-old woman who presented with severe anemia, low blood counts, and hepatosplenomegaly. Her blood tests revealed cold agglutinins and a positive DAT, and further evaluation identified B-cell acute lymphoblastic leukemia (B-ALL), confirming secondary cold AIHA. The second patient was a 55-year-old woman who presented with anemia, jaundice, and evidence of hemolysis, leading to a diagnosis of warm AIHA. The third patient was an 18-year-old woman who presented with severe anemia and splenomegaly. Her blood tests demonstrated both warm and cold antibody activity, and she was diagnosed with mixed AIHA. All three patients were treated with appropriate therapies and supportive care, resulting in clinical and hematological improvement. This case series illustrates the different ways AIHA can present and highlights the need for detailed immunohematological testing to identify the exact type, as well as the differences in treatment and management across AIHA subtypes. It also emphasizes the importance of searching for an underlying cause, as this guides treatment and improves outcomes.