Hemolytic anemia classification

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

Overview

There are many types of hemolytic anemias and the general classification of hemolytic anemia is either acquired or inherited.

Classification

Types of Hemolytic Anemias

• Secondary immune hemolytic anemia
• Idiopathic autoimmune hemolytic anemia
• Non-immune hemolytic anemia caused by chemicals or toxins
• Microangiopathic hemolytic anemia (MAHA)
• Sickle-cell anemia
• Hemoglobin SC disease (similar in symptoms to sickle-cell anemia)
• Thalassemia
• Hemolytic anemia due to G6PD deficiency
• Paroxysmal nocturnal hemoglobinuria (PNH)
• Hereditary elliptocytosis
• Hereditary ovalocytosis
• Hereditary spherocytosis
• Malaria
• Transfusion of blood from a donor with a different blood type

Hemolytic anemias can be either genetic or acquired.

Genetic

• Genetic conditions of RBC membrane
  • Hereditary spherocytosis
  • Hereditary elliptocytosis
• Genetic conditions of RBC metabolism (enzyme defects)
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD or favism)
  • Pyruvate kinase deficiency
• Genetic conditions of hemoglobin
  • Sickle cell anemia
  • Thalassemia

Acquired

Acquired hemolytic anemia can be further divided into immune and non-immune mediated.

Immune mediated hemolytic anaemia (direct Coombs test is positive)

• Autoimmune hemolytic anemia
  • Warm antibody autoimmune hemolytic anemia
    • Idiopathic
    • Systemic lupus erythematosus (SLE)
    • Evans' syndrome (antiplatelet antibodies and haemolytic antibodies)
  • Cold antibody autoimmune hemolytic anemia
    • Idiopathic cold hemagglutinin syndrome
    • Infectious mononucleosis and mycoplasma ( atypical) pneumonia
    • Paroxysmal cold hemoglobinuria (rare)
• Alloimmune hemolytic anemia
  • Haemolytic disease of the newborn (HDN)
    • Rh disease (Rh D)
    • ABO hemolytic disease of the newborn
    • Anti-Kell hemolytic disease of the newborn
    • Rhesus c hemolytic disease of the newborn
    • Rhesus E hemolytic disease of the newborn
    • Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, MN, P and others)
  • Alloimmune hemolytic blood transfusion reactions (ie from a non-compatible blood type)
• Drug induced immune mediated hemolytic anemia
  • Penicillin (high dose)
  • Methyldopa

Non-immune mediated hemolytic anemia (direct Coombs test is negative)

• Drugs (i.e., some drugs and other ingested substances lead to hemolysis by direct action on RBCs)
• Toxins (e.g., snake venom)
• Trauma
  • Mechanical (heart valves, extensive vascular surgery, microvascular disease)
• Microangiopathic hemolytic anemia (a specific subtype with causes such as TTP, HUS, DIC and HELLP syndrome)
• Infections
  • Malaria
  • Babesiosis
  • Septicaemia
• Membrane disorders
  • Paroxysmal nocturnal hemoglobinuria (rare acquired clonal disorder of red blood cell surface proteins)
  • Liver disease