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==Differentiating Hemolytic anemia from other Diseases==
==Differentiating Hemolytic anemia from other Diseases==


*'''Ineffective hematopoiesis''' is sometimes misdiagnosed as hemolysis.
{| class="wikitable"
** Clinically these conditions may share many features of hemolysis
! scope="col" | Characteristic/Parameter
** Red cell breakdown occurs before a fully developed red cell is released into the circulation.
! scope="col" | '''HIT'''
** Examples: [[thalassemia]], [[myelodysplastic syndrome]]
! scope="col" | '''DIC'''
* [[Megaloblastic anemia]] due to deficiency in [[vitamin B12]] or [[folic acid]].
! scope="col" | '''HUS'''<ref name="pmid28416508">{{cite journal| author=Jokiranta TS| title=HUS and atypical HUS. | journal=Blood | year= 2017 | volume= 129 | issue= 21 | pages= 2847-2856 | pmid=28416508 | doi=10.1182/blood-2016-11-709865 | pmc=5445567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28416508  }} </ref>
 
! scope="col" | '''Atypical HUS'''
===Differentiating Drug-Induced Autoimmune Hemolytic Anemia from other Diseases===
! scope="col" | '''ITP'''
[[Penicillin]] in high doses can induce immune mediated [[hemolysis]]<ref name="pmid10815791">{{cite journal |author=Stroncek D, Procter JL, Johnson J |title=Drug-induced hemolysis: cefotetan-dependent hemolytic anemia mimicking an acute intravascular immune transfusion reaction |journal=Am. J. Hematol. |volume=64 |issue=1 |pages=67–70 |year=2000 |month=May |pmid=10815791 |doi= |url=http://dx.doi.org/10.1002/(SICI)1096-8652(200005)64:1<67::AID-AJH12>3.0.CO;2-Z}}</ref> via the [[hapten]] mechanism in which antibodies are targeted against the combination of [[penicillin]] in association with [[red blood cell]]s. Complement is activated by the attached antibody leading to the removal of [[red blood cell]]s by the spleen.  
! scope="col" | '''PTP'''
 
! scope="col" | '''SLE'''
The drug itself can be targeted by the [[immune system]], e.g. by [[IgE]] in a [[Type I hypersensitivity reaction]] to [[penicillin]], rarely leading to [[anaphylaxis]].
|-
! scope="row" | Symptoms
| [[Bleeding]], [[thrombosis]], [[Necrosis|skin necrosis]]
| [[Bleeding]], [[thrombosis]], [[petechiae]], [[sepsis]]
| [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]]
| [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]]
| [[Petechiae]], [[bleeding]], other [[autoimmune diseases]]
| [[Petechia]]<nowiki/>e, [[purpura]], [[ecchymoses]]
| [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]]
|-
! scope="row" | Platelet count
| Low but usually more than 20000 per microliter
| Low
| Low
| Low
| Low; can be as low as 10000 per microliter
| Low; can be less than 10000 per microliter; sudden onset after [[transfusion]]
| Variable; usually low
|-
! scope="row" | PT and PTT
| Normal
| Elevated
| Normal
| Normal
| Normal
| Normal
| Usually normal
|-
! scope="row" | Etiology
| [[Heparin]] exposure
| [[Sepsis]], delivery of fetus, [[acute promyelocytic leukemia]], other [[malignancy]]
| [[Escherichia coli O157:H7|E.coli strain O157:H7]]; [[Shiga-like toxin]]
| Dysregulation of [[Complement|complement activation]]; mutation in [[Factor H|complement factor H]]
| Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]]
| Exposure to transfused products
| Autoimmunity with development of [[antibodies]] to [[DNA]]
|-
! scope="row" | Drug-related
| Yes, always
| Possible
| No
| No
| Yes
| No; transfusion-related
| Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]]
|-
! scope="row" | Bleeding
| Possible
| Usually
| Usually
| Usually
| Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter
| Yes; spontaneous bleeding if platelet count < 10000 per microliter
| Rare
|}


==References==
==References==

Revision as of 02:13, 3 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Hemolytic anemia from other Diseases

Characteristic/Parameter HIT DIC HUS[1] Atypical HUS ITP PTP SLE
Symptoms Bleeding, thrombosis, skin necrosis Bleeding, thrombosis, petechiae, sepsis Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Petechiae, bleeding, other autoimmune diseases Petechiae, purpura, ecchymoses Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Platelet count Low but usually more than 20000 per microliter Low Low Low Low; can be as low as 10000 per microliter Low; can be less than 10000 per microliter; sudden onset after transfusion Variable; usually low
PT and PTT Normal Elevated Normal Normal Normal Normal Usually normal
Etiology Heparin exposure Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy E.coli strain O157:H7; Shiga-like toxin Dysregulation of complement activation; mutation in complement factor H Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori Exposure to transfused products Autoimmunity with development of antibodies to DNA
Drug-related Yes, always Possible No No Yes No; transfusion-related Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid
Bleeding Possible Usually Usually Usually Yes; spontaneous bleeding if platelet count < 10000 per microliter Yes; spontaneous bleeding if platelet count < 10000 per microliter Rare

References

  1. ↑ Jokiranta TS (2017). "HUS and atypical HUS". Blood. 129 (21): 2847–2856. doi:10.1182/blood-2016-11-709865. PMC 5445567. PMID 28416508.

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