Hemolytic anemia resident survival guide: Difference between revisions
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The approach to diagnosis of hemolytic anemia is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of hemolytic anemia. | The approach to diagnosis of hemolytic anemia is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of hemolytic anemia. | ||
{{familytree/start |summary=Hemolytic anemia.}} | {{familytree/start |summary=Hemolytic anemia.}} | ||
{{familytree | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the symptoms:''' <br> ❑ [[Weakness]] <br> ❑ [[ | {{familytree | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the symptoms:''' <br> ❑ [[Weakness]] <br> ❑ [[Shortness of breath]] <br> ❑ [[Jaundice]]<br> ❑ [[Lethargy]]<br> ❑ [[Chest pain]] and reduced exercise tolerance<br> ❑ [[Pica]]</div> }} | ||
{{familytree | | | | |!| | | | }} | {{familytree | | | | |!| | | | }} | ||
{{familytree | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Examine the patient:'''<BR>❑ [[Tachypnea]]<BR>❑ Cold and clammy skin <br>❑ [[Hypotension]]<BR>❑ HEENT signs: | {{familytree | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Examine the patient:'''<BR>❑ [[Tachypnea]]<BR>❑ Cold and clammy skin <br>❑ [[Hypotension]]<BR>❑ HEENT signs: | ||
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* Bronze skin colour in case of repeated transfusions | * Bronze skin colour in case of repeated transfusions | ||
* Leg [[ulcer]]s | * Leg [[ulcer]]s | ||
<BR></div>}} | <BR>❑ [[Fever]] and neurological signs are seen in [[TTP]] <br>❑ [[Hemoglobinuria]] in some cases</div>}} | ||
{{familytree | | | | {{familytree | | | | |!| | | | }} | ||
{{familytree | | C01 | | | {{familytree | | | | C01 | | | C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Initial workup for hemolysis:'''<br> ❑ Indirect [[bilirubin]] <br>❑ serum [[haptoglobin]] <br>❑ [[Lactate dehydrogenase]] level <br>❑ [[Reticulocyte]] count <br>❑ [[Urinalysis]]</div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 17:49, 30 July 2020
| Hemolytic anemia Resident Survival Guide |
|---|
| Overview |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Overview
- Anemia is defined as a decrease in red blood cell population in the body. Hemolytic anemia results from a premature destruction of RBCs.
- Hemolysis can be due to either extravascular or intravascular destruction of cells[1].
- It is caused due to a wide variety of reasons which include inherited diseases like thalassemia, sickle cell disease etc, infections, autoimmune conditions, bone marrow dysfunction, blood transfusions and certain drugs can also result in hemolytic anemia [2].
- Most common presenting symptoms are fatigue, palpitations, dyspnea, tachycardia and icterus in severe cases.
- Diagnosis usually requires a battery of tests including, but not limited to a peripheral smear, CBC, serum LDH, bone marrow studies, etc.
- Treatment is directed by the specific cause and can involve bone marrow transplant, splenectomy, transfusions etc[3].
Causes
Life threatening causes
- ABO incompatibility
- Disseminated intravascular coagulation
- Thrombotic thrombocytopenic purpura
- Hemolytic uremic syndrome
- Pre-eclampsia and malignant hypertension
Other causes
- Membrane cytoskeletal defects like hereditary spherocytosis and hereditary elliptocytosis [4]
- Glucose 6 phosphate dehydrogenase deficiency
- Pyruvate kinase deficiency
- Sickle cell disease
- Thalassemia
- Cold agglutinin disease
- Drug induced hemolytic anemia
- Systemic lupus erythematosus
- Prosthetic heart valves
- Infectious causes such as malaria, hepatitis, CMV infection etc.
For a complete list of hemolytic anemia causes click here
FIRE
Diagnosis
The approach to diagnosis of hemolytic anemia is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of hemolytic anemia.
Characterize the symptoms: ❑ Weakness ❑ Shortness of breath ❑ Jaundice ❑ Lethargy ❑ Chest pain and reduced exercise tolerance ❑ Pica | |||||||||||||||||
Examine the patient: ❑ Tachypnea ❑ Cold and clammy skin ❑ Hypotension ❑ HEENT signs:
❑ Fever and neurological signs are seen in TTP ❑ Hemoglobinuria in some cases | |||||||||||||||||
Initial workup for hemolysis: ❑ Indirect bilirubin ❑ serum haptoglobin ❑ Lactate dehydrogenase level ❑ Reticulocyte count ❑ Urinalysis | |||||||||||||||||
Treatment
Do's
Don'ts
References
- ↑ Phillips J, Henderson AC (2018). "Hemolytic Anemia: Evaluation and Differential Diagnosis". Am Fam Physician. 98 (6): 354–361. PMID 30215915.
- ↑ Renard D, Rosselet A (2017). "Drug-induced hemolytic anemia: Pharmacological aspects". Transfus Clin Biol. 24 (3): 110–114. doi:10.1016/j.tracli.2017.05.013. PMID 28648734.
- ↑ Morishita E (2015). "[Diagnosis and treatment of microangiopathic hemolytic anemia]". Rinsho Ketsueki. 56 (7): 795–806. doi:10.11406/rinketsu.56.795. PMID 26251142.
- ↑ Barcellini W, Bianchi P, Fermo E, Imperiali FG, Marcello AP, Vercellati C; et al. (2011). "Hereditary red cell membrane defects: diagnostic and clinical aspects". Blood Transfus. 9 (3): 274–7. doi:10.2450/2011.0086-10. PMC 3136593. PMID 21251470.