hemolytic anemia

Definition. Hemolytic anemias are caused by decreased red blood cell survival from increased
destruction of the cells. The destruction may be either in the blood vessels (intravascular) or
outside the vessels (extravascular), which generally means inside the spleen.

Etiology. Hemolytic anemias may either be chronic as in sickle cell disease,paroxysmal nocturnal
hemoglobinuria, and hereditary spherocytosis or acute such as in drug-induced hemolysis, autoimmune
hemolysis, or glucose 6-phosphate dehydrogenase deficiency

in sickle cell disease,paroxysmal nocturnal
hemoglobinuria, and hereditary spherocytosis

drug-induced hemolysis, autoimmune
hemolysis, or glucose 6-phosphate dehydrogenase deficiency

The major difference between hemolytic
anemia and the micro- and macrocytic anemias is that hemolysis is more often the etiology
when the onset is sudden. This is, of course, provided that simple blood loss has been excluded.

Hemolysis is often associated with jaundice and dark urine as well. Specific findings associated
with each disease are described below. .

Fever, chills, chest pain, tachycardia, and backache may
occur if the intravascular hemolysis is particularly rapid

Patients with hemolytic anemias generally have a normal MC~ but the MCV may
be slightly elevated because reticulocytes are somewhat larger than older cells.

Hemolysis shows the following:
Elevated indirect bilirubin level
Elevated reticulocyte count
Elevated LDH level
Decreased haptoglobin level

With hemolysis, order a peripheral smear, LDH, biliru bin level, reticulocyte
count, and haptoglobin level on the first CCS screen

Intravascular hemolysis also shows the following:
• Abnor mal peripheral smear (schisrocytcs, helmet cells, fragmented cells)
Hemoglobinuria
• Hemosiderinuria (metabolic. oxidized product of hemoglobin in the urine)

up break down of cells)

down -increased cell production using is up
folate stores are limited

bilir stones

increased but if more than 4 mg/dl- it s unusual

fragmanted cells

low in intravasculatr hemolysis

if intravasc hemolysis is sudden and severe- blodd spills in to urine

no, because indirect bilirubin bound to albumin and should not filtrate into urine and

it is product of hemoglobin and can be present in urine if hemolysis is severe and last for several days

both have spherocytes with central pallor but in autoimmune will be + coombs tests and no strong familty history .
in spherocytosis is strong fa,ily history and (-) coombs tests
both are extravascular hemolysos