Autoimmune hemolytic anemia differential diagnosis: Difference between revisions

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Revision as of 01:13, 2 April 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S; Shyam Patel [2]

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Overview

Differentiating Autoimmune hemolytic anemia from other Diseases

Diagnosis is made by first ruling out other causes of hemolytic anemia, such as G6PD, thalassemia, sickle-cell disease, etc.

Characteristic	Causes	Pathophysiology	Laboratory abnormalities	Physical examination	Therapy	Other associations
Autoimmune hemolytic anemia	Abnormal immune activation^[1] Failure of self vs. non-self recognition^[1] Infections Chronic lymphocytic leukemia non-Hodgkin's lymphoma Rheumatologic disease	Polyclonal antibody production that binds to and targets red blood cells for destruction intravascurly or extravascularly^[1]	Positive Coombs' test for IgG Indirect hyperbilirubinemia Reticulocytosis Low haptoglobin Elevated LDH	Pallor Jaundice Shortness of breath Tachypnea	Removal of offending agent Corticosteroids Cyclophosphamide Cyclosporine A Azathioprine Rituximab Splenectomy	Hemolysis can occur at warm or cold temperatures
Paroxysmal cold hemoglobinuria	Production of Donath-Landsteiner antibody, triggered by viral or bacterial infection^[2]	Biphasic hemolysin (IgG) that binds red blood cells and low temperatures and triggers complement-mediated intravascular hemolysis at warm temperatures^[2]	Positive Donath-Landsteiner antibody Microscopic hematuria Negative Coombs' test for IgG or C3d Negative cold agglutinin titer Indirect hyperbilirubinemia Reticulocytosis Low haptoglobin Elevated LDH	Hematuria in the presence of cold weather Jaundice	Removal of offending agent Steroids Alternative immunosuppression	Associated with syphilis^[2] Maternal IgG can cross the placenta and affect the fetus^[2]
Hereditary spherocytosis^[3]	Mutation in ankyrin^[3] Mutation in alpha- or beta-spectrin^[3] Mutation in band 3^[3] Mutation in protein 4.2^[3]	Diminished membrane integrity^[3] Increased red blood cell fragility Splenic destruction of deformed red blood cells	Positive eosin-5-maleimide binding to red blood cells^[3] Positive osmotic fragility testing^[3] Spherocytes on peripheral blood smear	Pallor Jaundice Splenomegaly	Removal of offending medication High-dose vitamin B6 (up to 200mg daily) Avoidance of splenectomy Symptomatic transfusion support with iron chelation as needed	Can be autosomal dominant or recessive
Thalassemia	Genetic defect with alpha- or beta-globin production	Microcytic (<80 femtoliter)	Abnormal hemoglobin electrophoresis (in beta-thalassemia)	Irritability Growth retardation Jaundice Hepatomegaly Splenomegaly	Transfusion support Iron chelation Gene therapy if available	Extramedullary hematopoiesis
Iron deficiency anemia	Loss of iron from gastrointestinal blood loss or menstrual blood loss	Microcytic (<80 femtoliter)	Low serum iron Elevated transferrin Low transferrin saturation Low ferritin	Pallor Weakness Positive occult blood testing (if GI bleeding)	Intravenous or oral iron supplementation	Chronic blood loss
Pernicious anemia	Vitamin B12 deficiency	Macrocytic (>100 femtoliter)	Low vitamin B12 level Presence of anti-intrinsic factor or anti-parietal cell antibody	Numbness Weakness Tingling Paresthesias	Vitamin B12 1000mcg daily	Autoimmune disorders
Chronic lymphocytic leukemia	Mutations in hematopoietic stem cells and B lymphocytes	Clonal proliferation of malignant B lymphocytes	Elevated absolute lymphocyte count Anemia (Rai stage III) and thrombocytopenia (Rai stage IV)	Numbness Weakness Tingling Paresthesias	Vitamin B12 1000mcg daily	Secondary autoimmune hemolytic anemia occurs in advanced CLL; treatment with corticosteroids or anti-leukemic therapy will correct the underlying anemia

References

↑ ^1.0 ^1.1 ^1.2 Berentsen S, Sundic T (2015). "Red blood cell destruction in autoimmune hemolytic anemia: role of complement and potential new targets for therapy". Biomed Res Int. 2015: 363278. doi:10.1155/2015/363278. PMC 4326213. PMID 25705656.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Akpoguma AO, Carlisle TL, Lentz SR (2015). "Case report: paroxysmal cold hemoglobinuria presenting during pregnancy". BMC Hematol. 15: 3. doi:10.1186/s12878-015-0023-7. PMC 4334594. PMID 25699184.
↑ ^3.0 ^3.1 ^3.2 ^3.3 ^3.4 ^3.5 ^3.6 ^3.7 Gallagher PG (2013). "Abnormalities of the erythrocyte membrane". Pediatr Clin North Am. 60 (6): 1349–62. doi:10.1016/j.pcl.2013.09.001. PMC 4155395. PMID 24237975.

Template:Hematology

Template:WikiDoc Sources

[pmid25705656-1] 1.0 ^1.1 ^1.2 Berentsen S, Sundic T (2015). "Red blood cell destruction in autoimmune hemolytic anemia: role of complement and potential new targets for therapy". Biomed Res Int. 2015: 363278. doi:10.1155/2015/363278. PMC 4326213. PMID 25705656.

[pmid25699184-2] 2.0 ^2.1 ^2.2 ^2.3 Akpoguma AO, Carlisle TL, Lentz SR (2015). "Case report: paroxysmal cold hemoglobinuria presenting during pregnancy". BMC Hematol. 15: 3. doi:10.1186/s12878-015-0023-7. PMC 4334594. PMID 25699184.

[pmid24237975-3] 3.0 ^3.1 ^3.2 ^3.3 ^3.4 ^3.5 ^3.6 ^3.7 Gallagher PG (2013). "Abnormalities of the erythrocyte membrane". Pediatr Clin North Am. 60 (6): 1349–62. doi:10.1016/j.pcl.2013.09.001. PMC 4155395. PMID 24237975.

[1]

[2]

[3]

@@ Line 78: / Line 78: @@
 * Maternal IgG can cross the placenta and affect the fetus<ref name="pmid25699184">{{cite journal| author=Akpoguma AO, Carlisle TL, Lentz SR| title=Case report: paroxysmal cold hemoglobinuria presenting during pregnancy. | journal=BMC Hematol | year= 2015 | volume= 15 | issue=  | pages= 3 | pmid=25699184 | doi=10.1186/s12878-015-0023-7 | pmc=4334594 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25699184  }} </ref>
 |-
-|[[Hereditary spherocytosis]]
+|[[Hereditary spherocytosis]]<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
 |
-* [[Alcoholism]]
+* Mutation in ankyrin<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* [[Lead poisoning]]
+* Mutation in alpha- or beta-spectrin<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* [[Vitamin B6 deficiency]]
+* Mutation in band 3<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* [[Isoniazid]]
+* Mutation in protein 4.2<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* [[Chloramphenicol]]
 |
-* [[Microcytic anemia|Microcytic]] (<80 femtoliter)
+* Diminished membrane integrity<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-Or
+* Increased [[red blood cell]] fragility
-* [[Normocytic anemia|Normocytic]] (80-100 femtoliter)
+* Splenic destruction of deformed [[red blood cells]]
 |
-* Ringed sideroblasts in [[bone marrow]]
+* Positive eosin-5-maleimide binding to [[red blood cells]]<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* Low [[vitamin B6]] level
+* Positive osmotic fragility testing<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
-* High [[lead]] level
+* Spherocytes on peripheral blood smear
 |
 * [[Pallor]]
+* [[Jaundice]]
-* [[Muscle weakness|Weakness]]
+* [[Splenomegaly]]
 |
 * Removal of offending [[medication]]
@@ Line 103: / Line 102: @@
 * Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed
 |
-* [[Myelodysplastic syndrome]]
+* Can be autosomal dominant or recessive
-* [[Myeloproliferative neoplasm]]
-* [[Iron overload]]
 |-
 |[[Thalassemia]]

Autoimmune hemolytic anemia differential diagnosis: Difference between revisions

Revision as of 01:13, 2 April 2018

Overview

Differentiating Autoimmune hemolytic anemia from other Diseases

References

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