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Severe autoimmune hemolytic anemia (AIHA) is characterized by the destruction of red blood cells due to the body’s immune system incorrectly identifying them as foreign. One of the hallmark symptoms associated with this condition is jaundice, which occurs when there is an increased breakdown of red blood cells. As red blood cells are hemolyzed, they release hemoglobin into the bloodstream, which is then converted into bilirubin by the liver. An overload of bilirubin can lead to the characteristic yellowing of the skin and sclera (the whites of the eyes) known as jaundice.

While hyperactivity, weight gain, and frequent infections could be observed in various conditions, they do not specifically relate to the direct effects of severe AIHA. Hyperactivity is not a typical symptom of anemia, and weight gain is generally not associated with any form of anemia, including AIHA, as anemia usually leads to fatigue and a decrease in energy levels. Frequent infections can occur in patients with compromised immune function, but they are not a symptom directly tied to severe AIHA itself. Therefore, jaundice stands out as the primary symptom that is unmistakably linked to the hemolytic process occurring in severe AIHA.