Diagnosis of hemolytic anemia in the adult
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders; Red Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
Hemolytic anemia is defined as anemia due to a shortened survival of circulating red blood cells (RBCs) due to their premature destruction. There are numerous causes of hemolytic anemia, including inherited and acquired conditions, acute and chronic processes, and mild to potentially life-threatening severity. Occasionally the cause will be obvious from the history, physical examination, or findings on the peripheral blood smear, but often the ultimate diagnosis requires a synthesis of all of this information and additional laboratory testing.
The key finding that suggests hemolytic anemia is an increase in the reticulocyte count that is not explained by recent bleeding or recent correction of iron deficiency or other nutrient deficiency. Patients may also have evidence of RBC destruction including increased lactate dehydrogenase (LDH) and bilirubin, decreased haptoglobin, and spherocytes on the peripheral blood smear.
The causes of hemolytic anemia and a diagnostic approach to the adult with unexplained hemolytic anemia are discussed here. Other topic reviews present general approaches to determining the cause of anemia and diagnosis of specific types of hemolytic anemia:
●General approach, child – (See "Approach to the child with anemia".)
●General approach, adult – (See "Approach to the adult patient with anemia".)
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- RBC TURNOVER IN HEMOLYTIC ANEMIA
- CONCEPTUAL FRAMEWORK
- Intracorpuscular versus extracorpuscular defects
- - Intracorpuscular defects
- - Extracorpuscular defects
- Immune versus non-immune
- Site of RBC destruction
- - Intravascular hemolysis
- - Extravascular hemolysis
- LIST OF CAUSES
- DIAGNOSTIC APPROACH
- Overview of the evaluation
- History and physical examination
- Laboratory confirmation of hemolysis
- - CBC/blood smear review
- - High reticulocyte count
- - High LDH and bilirubin; low haptoglobin
- Immediate management issues before the cause is identified
- Testing to determine the cause of hemolysis
- ATYPICAL PRESENTATIONS
- Hemolysis without reticulocytosis
- Hemolysis without anemia
- Reticulocytosis without hemolysis
- THROMBOTIC COMPLICATIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS