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Getting winded after climbing stairs or walking across a room can be frustrating, especially when everyday activities used to feel easy.
With autoimmune hemolytic anemia (AIHA), shortness of breath can be a sign that your blood isn’t carrying as much oxygen as your body needs.
Breathing trouble with AIHA is often more noticeable during activity. In more severe anemia, it may also happen at rest. Understanding why AIHA causes shortness of breath, what may help, and when to get medical care can help you respond when this symptom appears.
AIHA happens when the immune system mistakenly destroys red blood cells, a process known as hemolysis. In warm AIHA, the most common type, antibodies attach to red blood cells at normal body temperature and mark them for destruction by the spleen.
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If red blood cells are destroyed faster than the bone marrow can replace them, anemia develops. Because red blood cells contain hemoglobin, the protein that carries oxygen throughout the body, anemia can reduce the amount of oxygen reaching your tissues.
When your body isn’t getting as much oxygen as it needs, your heart and lungs may work harder to make up for it. Anemia can therefore cause shortness of breath, along with:
Breathlessness may be especially noticeable during physical exertion like walking, climbing stairs, housework, or exercise because your muscles need more oxygen during those types of activities.
Symptoms can also depend on how quickly anemia develops. A rapid drop in red blood cells may cause more noticeable symptoms because the body has less time to adjust.
Shortness of breath is a recognized symptom of warm AIHA, but researchers don’t have a precise estimate of how many people experience it. Because warm AIHA is so rare, studies of its symptoms often include relatively small groups, so their findings may not accurately represent everyone with the condition.
In a 2025 qualitative study of 20 adults with warm AIHA, six participants (30 percent) reported shortness of breath. Fatigue was reported by all 20 participants.
Shortness of breath can occur with other forms of AIHA as well because they can also cause anemia. Research hasn’t clearly shown that breathlessness is always worse in warm AIHA. However, warm AIHA can sometimes develop quickly and cause severe anemia, which may make breathing symptoms more noticeable.
Shortness of breath, also called dyspnea, can feel different from person to person. You may feel you:
With warm AIHA, breathlessness may be most noticeable during physical activity. In severe anemia, even activities such as showering, getting dressed, or walking a short distance may leave you winded. Some people may also feel short of breath while sitting or resting when their disease is active.
A 2025 study of 15 people with warm AIHA-related dyspnea looked more closely at how breathlessness affected daily life. All participants reported that physical exertion typically triggered their symptoms and rest helped relieve them.
In the study, 14 of 15 had difficulty walking, 11 had difficulty climbing stairs, and 11 reported needing frequent rest breaks or avoiding physical activity. Meanwhile, 12 described emotional effects such as anxiety, panic, anger, or frustration, and eight reported effects on work.
Other symptoms may occur along with shortness of breath. Warm AIHA can cause symptoms of both anemia and red blood cell destruction, including:
Symptoms don’t always feel the way you might expect based on lab results. A member of myAIHAteam asked, “Why do I have fatigue, chest vibrations, and shortness of breath when my hemoglobin numbers are good?”
How you feel can depend on more than your hemoglobin level at one point in time. The severity of anemia symptoms can also depend on how quickly anemia develops, and shortness of breath can have causes other than anemia.
The main way to manage AIHA-related shortness of breath is to treat the hemolysis and anemia causing it. Treatment for warm AIHA aims to slow red blood cell destruction and improve hemoglobin levels.
Your treatment plan could depend on several factors, including:
Improving the anemia may help reduce breathlessness and other symptoms caused by poor oxygen delivery.
Corticosteroids have traditionally been used as first-line treatment for warm AIHA. These medications reduce immune system activity, which may slow the destruction of red blood cells.
When corticosteroids don’t work well enough or the condition returns, other treatments may be considered. Options can include rituximab, other medications that affect the immune system, or splenectomy, which is surgery to remove the spleen.
People with severe, symptomatic anemia may also need a red blood cell transfusion. A transfusion can raise the number of circulating red blood cells while treatments aimed at controlling hemolysis begin to work.
Treatment options for warm AIHA are changing. In August 2026, nipocalimab-aahu (Imaavy) became the first medication approved specifically for warm AIHA in people age 12 and older who are currently taking or have previously taken corticosteroids. Other targeted treatments for warm AIHA are also being studied in clinical trials.
Shortness of breath has many possible causes besides anemia. These may include:
Contact your healthcare provider if breathlessness is new, becoming more frequent, or happening with less activity than before. If the cause isn’t clear, your healthcare provider may do some testing to find out the cause.
New or rapidly worsening shortness of breath deserves prompt attention. Seek emergency medical care for severe shortness of breath that begins suddenly, particularly when it occurs with symptoms such as chest pain, fainting, or changes in alertness.
Seek urgent medical help for:
People with warm AIHA also have an increased risk of blood clots. A clot that travels to the lungs, called a pulmonary embolism, can cause sudden shortness of breath, chest pain, or fainting and requires prompt medical evaluation.
You know what your usual level of breathlessness feels like. A major or sudden change is a reason to get medical advice rather than assuming the symptom is simply part of AIHA.
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