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Laboratory Testing in Hemolytic Anemia

Intravascular vs Extravascular Hemolysis
Reticulocytes
Unconjugated bilirubin
LDH
Peripheral smear
Haptoglobin
Urine hemosiderin
Urine hemoglobin
Carboxyhemoglobin

#Hemolytic #Anemia #Laboratory #Testing #workup
Laboratory Testing ... in Hemolytic Anemia ... Extravascular Hemolysis ... #Anemia #Laboratory ... #Testing #workup
Peripheral Blood Smear Analysis
Hypochromia
Megaloblastic Anemia
Schistocytes: Microangiopathic hemolytic anemia (e.g. DIC, TTP, HUS)
Microspherocytes: Autoimmune hemolytic anemia
Sickled red
Peripheral Blood ... Microangiopathic hemolytic ... Microspherocytes: Autoimmune hemolytic ... , Thalassemia Basophilic ... #Peripheral #Blood
Hemolytic Anemia - Differential Diagnosis Algorithm
Hereditary:
 • Peripheral blood smear + DAT + further History
 •
Hemolytic Anemia ... • Peripheral blood ... → Sickle Cell anemia ... anemia (TTP, HUS ... #Anemia #Differential
Warm Antibody Autoimmune Hemolytic Anemia 
1) DIAGNOSE AIHA
 • Anemia: macrocytic > normocytic, ↑ reticulocytes
 •
Antibody Autoimmune Hemolytic ... Anemia 1) DIAGNOSE ... AIHA • Anemia ... type ± C3d • Blood ... #Anemia #diagnosis
Hemolytic Anemia - Differential Diagnosis Algorithm
 • Sickle cells - Consider sickle cell disease (diverse genotypes):
Hemolytic Anemia ... thalassemia, S Lepore • Basophilic ... ARUPConsult @ARUPLabs #Hemolytic ... #Anemia #Differential ... workup #hematology #testing
Peripheral blood findings in microangiopathic hemolytic anemia.  DIC is a clinical and laboratory diagnosis, not
Peripheral blood ... microangiopathic hemolytic ... anemia. ... anemia is characterized ... coagulation and other testing
Common RBC Inclusions and Associations
 • Howell Jolly Bodies: Hyposplenism, Asplenism, Severe hemolytic anemia
 • Heinz
Asplenism, Severe hemolytic ... anemia • Heinz ... Sideroblastic anemia ... , Hemolytic anemia ... Hemoglobin H disease • Basophilic
Coombs Test - Direct vs Indirect

#Diagnosis #Testing #Coombs #Direct #Indirect #Hemolytic #Anemia
#Diagnosis #Testing ... Direct #Indirect #Hemolytic ... #Anemia
Red Blood Cell (RBC) Morphology
Microcytic RBC: Pyridoxine deficiency, Thalassemia, Iron deficiency anemia, Chronic disease anemia (sometimes),
Red Blood Cell ( ... disease, McLeod blood ... Microangiopathic Hemolytic ... spherocytosis, Autoimmune hemolytic ... Cold autoimmune hemolytic
Reticulocyte Production Index = (Retic %) x (Hct / 45) / Maturation Factor
The maturation factor is
the peripheral blood ... including chronic blood ... > 3: • Acute blood ... Retroperitoneal, Uterine • Hemolysis ... Microangiopathic hemolytic