Haemolysis

Keywords: Haemolytic anaemia

Causes

Appropriate Tests

 

Full blood count, Blood film, Reticulocyte count, Bilirubin, Lactate dehydrogenase. Haptoglobin may be useful for documentation and monitoring.

If acute intra-vascular haemolysis suspected: Schumm's test; Haemoglobin urine.

If chronic intravascular haemolysis suspected: Haemoglobin urine.

Active haemolysis may be present without anaemia if bone marrow reserve is sufficient.

See also Haemolysis (neonatal)

With red cell spherocytosis

Direct antiglobulin test.

Further investigation - consult pathologist.

Autoimmune haemolysis, including

  • Incompatible transfusion
  • Haemolytic disease of the newborn

 

See Immediate and delayed transfusion reactions under Blood transfusion - complications.

Hereditary spherocytosis

 

Severe burns

Blood film may also show red cell fragmentation.

Clostridium perfringens septicaemia

 

With red cell fragmentation ± spherocytosis

 

Microangiopathic haemolysis

 

Drug-induced oxidative haemolysis, especially

  • Salicylazosulphapyridine
  • Dapsone
  • Phenacetin
  • Primaquine

Heinz body preparation ± Methaemoglobin, Sulphaemoglobin.

Consider possibility of underlying intrinsic red cell defect.

 

Particularly in patients with G-6-PD deficiency.

Intrinsic red cell defects, especially

 

  • Haemoglobinopathy - unstable

Unstable haemoglobin screening test, Haemoglobin electrophoresis.

  • G-6-PD deficiency

 

  • Pyruvate kinase deficiency

Pyruvate kinase - red cell assay.

  • Other red cell enzyme deficiency

Autohaemolysis test, further investigation in specialised laboratory.

With sickle cells

 

Sickle cell disorders

 

With normal red cell morphology

 

Hypersplenism

 

Paroxysmal nocturnal haemoglobinuria (PNH)

Flow cytometry evaluation; Paroxysmal nocturnal haemoglobinuria

Paroxysmal cold haemoglobinuria

Donath-Landsteiner Ab.

March haemoglobinuria 

Haemoglobin urine, after exercise.

Intrinsic red cell defects

Red cell morphology may be unremarkable in patients with sickle cell trait, G-6-PD deficiency or an unstable haemoglobinopathy, particularly when haemolysis is not active.

See also Haemoglobinopathy and Sickle cell disorders.

With red cell parasites

Parasites blood, Blood film.

Malaria

 

Babesiosis