Hemolytic anemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Differentiating Hemolytic anemia from other Diseases

Characteristic/Parameter	Hemolytic anemia	Sideroblastic anemia	Anemia of chronic disease	Thalassemia	Iron-deficiency anemia	Erythropoietin deficiency	Vitamin B12 deficiency	Folate deficiency
Etiology	Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease	Alcoholism, lead poisoning, vitamin B6 deficiency	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	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Mean corpuscular volume	Normocytic (80-100 femtoliter)	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	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Laboratory abnormalities	Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH	Elevated	Normal	Normal	Normal	Normal	Usually normal	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Physical exam	Pallor, jaundice	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	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Treatment	Removal of offending agent, steroids, alternative immunosuppression	Possible	No	No	Yes	No; transfusion-related	Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Other associated abnormalities	HELLP syndrome, TTP, CLL	Usually	Usually	Usually	Yes; spontaneous bleeding if platelet count < 10000 per microliter	Yes; spontaneous bleeding if platelet count < 10000 per microliter	Rare	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis