Hemolytic anemia laboratory findings

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

Overview

Hemolytic anemia is anemia caused secondary to shortened survival of circulating red blood cells. The normal life span of RBCs is 110 to 120 days RBC destruction below that time is defined as hemolytic anemia.

Laboratory Findings

• Peripheral blood smear microscopy:
  • Fragments of the red blood cells ("schistocytes") can be present.
  • Some red blood cells may appear smaller and rounder than usual (spherocytes).
  • Reticulocytes are present in elevated numbers. This may be overlooked if a special stain is not used.
• The level of unconjugated bilirubin in the blood is elevated. This may lead to jaundice.
• The level of lactate dehydrogenase (LDH) in the blood is elevated.
• Haptoglobin levels are decreased.
• The direct Coombs test is positive if hemolysis is caused by an immune process.
• Hemosiderin in the urine indicates chronic intravascular hemolysis. There is also urobilinogen in the urine.

(Images shown below are courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Hospital Universitario La Fe Servicio Hematologia)

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  Microangiopathic hemolytic anemia

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  Microangiopathic hemolytic anemia