Hemolytic anemia differential diagnosis: Difference between revisions
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| Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6 | | Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6 | ||
| Genetic defect with alpha- or beta-globin production | | Genetic defect with alpha- or beta-globin production | ||
| | | Loss of iron from gastrointestinal blood loss or menstrual blood loss | ||
| | | Chronic kidney disease or other renal dysfunction | ||
| [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]] | | [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]] | ||
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| Normocytic (80-100 femtoliter) | | Normocytic (80-100 femtoliter) | ||
| Microcytic (<80 femtoliter) | | Microcytic (<80 femtoliter) | ||
| | | Microcytic (<80 femtoliter) | ||
| | | Normocytic (80-100 femtoliter) | ||
| Variable; usually low | | Variable; usually low | ||
|- | |- | ||
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| Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | | Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | ||
| Abnormal hemoglobin electrophoresis (in beta-thalassemia) | | Abnormal hemoglobin electrophoresis (in beta-thalassemia) | ||
| | | Low serum iron, elevated transferrin, low transferrin saturation, low ferritin | ||
| | | Low erythropoietin level | ||
| Usually normal | | Usually normal | ||
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| Pallor, weakness | | Pallor, weakness | ||
| Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | | Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | ||
| | | Pallor, weakness, positive occult blood testing (if GI bleeding) | ||
| Pallor, weakness, signs of chronic kidney disease | |||
| Autoimmunity with development of [[antibodies]] to [[DNA]] | | Autoimmunity with development of [[antibodies]] to [[DNA]] | ||
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| Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | | Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | ||
| Transfusion support, iron chelation, gene therapy if available | | Transfusion support, iron chelation, gene therapy if available | ||
| | | Intravenous or oral iron supplementation | ||
| | | Epoetin alfa 50-100 units/kg 3 times weekly, darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks | ||
| Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]] | | Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]] | ||
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| Inflammatory bowel disease | | Inflammatory bowel disease | ||
| Extramedullary hematopoiesis | | Extramedullary hematopoiesis | ||
| | | Chronic blood loss | ||
| | | Dialysis dependence, myelodysplastic syndrome | ||
| Rare | | Rare | ||
|} | |} | ||
Revision as of 05:20, 5 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
Differentiating Hemolytic anemia from other Diseases
| Characteristic/Parameter | Hemolytic anemia | Sideroblastic anemia | Anemia of chronic disease | Thalassemia | Iron-deficiency anemia | Erythropoietin deficiency | Vitamin B12 or folate deficiency |
|---|---|---|---|---|---|---|---|
| Etiology | Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease | Alcoholism, lead poisoning, vitamin B6 deficiency, isoniazid, chloramphenicol | Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6 | Genetic defect with alpha- or beta-globin production | Loss of iron from gastrointestinal blood loss or menstrual blood loss | Chronic kidney disease or other renal dysfunction | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
| Mean corpuscular volume | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) | Microcytic (<80 femtoliter) | Normocytic (80-100 femtoliter) | Variable; usually low |
| Laboratory abnormalities | Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH | Ringed sideroblasts in bone marrow; low vitamin B6 level, high lead level | Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | Abnormal hemoglobin electrophoresis (in beta-thalassemia) | Low serum iron, elevated transferrin, low transferrin saturation, low ferritin | Low erythropoietin level | Usually normal |
| Physical exam | Pallor, jaundice | Pallor, weakness | Pallor, weakness | Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | Pallor, weakness, positive occult blood testing (if GI bleeding) | Pallor, weakness, signs of chronic kidney disease | Autoimmunity with development of antibodies to DNA |
| Treatment | Removal of offending agent, steroids, alternative immunosuppression | Removal of offending medication, high-dose vitamin B6 (up to 200mg daily), avoidance of splenectomy, symptomatic transfusion support with iron chelation as needed | Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | Transfusion support, iron chelation, gene therapy if available | Intravenous or oral iron supplementation | Epoetin alfa 50-100 units/kg 3 times weekly, darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks | Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid |
| Other associated abnormalities | HELLP syndrome, TTP, CLL | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | Inflammatory bowel disease | Extramedullary hematopoiesis | Chronic blood loss | Dialysis dependence, myelodysplastic syndrome | Rare |