Autoimmune hemolytic anemia differential diagnosis: Difference between revisions

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Revision as of 00:49, 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	Treatment	Other associated abnormalities
Autoimmune hemolytic anemia	Drug-induced Immune-mediated Non-immune-mediated Infections Rheumatologic disease	Immune-mediated destruction	Indirect hyperbilirubinemia Reticulocytosis Low haptoglobin Elevated LDH	Pallor Jaundice	Removal of offending agent Steroids Alternative immunosuppression	HELLP syndrome TTP CLL
Paroxysmal cold hemoglobinuria	Production of Donath-Landsteiner antibody, triggered by viral or bacterial infection^[1]	Bispecific hemolysin (IgG) that triggers complement-mediated intravascular hemolysis^[1]	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^[1] Maternal IgG can cross the placenta and affect the fetus^[1]
Hereditary spherocytosis	Alcoholism Lead poisoning Vitamin B6 deficiency Isoniazid Chloramphenicol	Microcytic (<80 femtoliter) Or Normocytic (80-100 femtoliter)	Ringed sideroblasts in bone marrow Low vitamin B6 level High lead level	Pallor Weakness	Removal of offending medication High-dose vitamin B6 (up to 200mg daily) Avoidance of splenectomy Symptomatic transfusion support with iron chelation as needed	Myelodysplastic syndrome Myeloproliferative neoplasm Iron overload
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 ^1.3 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.

Template:Hematology

Template:WikiDoc Sources

[pmid25699184-1] 1.0 ^1.1 ^1.2 ^1.3 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.

[1]

@@ Line 49: / Line 49: @@
 |Paroxysmal cold hemoglobinuria
 |
-* Production of [[Donath-Landsteiner antibody]]
+* Production of [[Donath-Landsteiner antibody]], triggered by viral or bacterial infection<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>
 |
-* Bispecific hemolysin that causes immune-mediated destruction
+* Bispecific hemolysin (IgG) that triggers complement-mediated intravascular hemolysis<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>
 |
 * Indirect [[hyperbilirubinemia]]
@@ Line 58: / Line 58: @@
 * Elevated [[LDH]]
 |
-* [[Pallor]]
+* [[Hematuria]] in the presence of cold weather
 * [[Jaundice]]
 |
@@ Line 65: / Line 65: @@
 * Alternative [[immunosuppression]]
 |
-* [[HELLP syndrome]]
+* Associated with syphilis<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>
-* [[TTP]]
+* 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>
-* [[Chronic lymphocytic leukemia|CLL]]
 |-
 |[[Hereditary spherocytosis]]
@@ Line 175: / Line 174: @@
 * Secondary autoimmune hemolytic anemia occurs in advanced CLL; treatment with corticosteroids or anti-leukemic therapy will correct the underlying anemia
 |}
 ==References==

Autoimmune hemolytic anemia differential diagnosis: Difference between revisions

Revision as of 00:49, 2 April 2018

Overview

Differentiating Autoimmune hemolytic anemia from other Diseases

References

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