Hemolytic Anemia - Differential Diagnosis Algorithm • Sickle cells - Consider sickle cell disease (diverse genotypes): SS, SC, SE, Sβ thalassemia, S Lepore • Basophilic stippling - Congenital 5' nucleotidase deficiency, lead poisoning • Polychromasia only with or without platelet decrease - PNH • Polychromasia without other reproducible morphologic abnormality - Pyruvate kinase deficiency, Hexokinase deficiency, Other enzyme defects • Agglutination - Cold agglutinins disease • Heinz bodies - Glucose-6-phosphate dehydrogenase deficiency, Unstable hemoglobin defects, Glutathione metabolism defects, Hemoglobin H disease • Schistocytes, thrombocytopenia - DIC, TTP, HELLP, HUS, aHUS, mechanical cardiac valve, vasculitis, malignant hypertension • Unusual RBC inclusions - If infection suspected, consider malaria, bartonella (oroya fever), babesia • Spherocytes, pyropoikilocytes, elliptocytes or acanthocytes - Consider RBC membrane disorder (hereditary spherocytosis, hereditary elliptocytosis, autoimmune hemolysis) ARUPConsult @ARUPLabs #Hemolytic #Anemia #Differential #Diagnosis #Algorithm #workup #hematology #testing
