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 before that time is defined as hemolytic anemia. As opposed to the normal senecence of RBC, the random hemolysis (premature RBC death) is increased in hemolytic anemia.

Laboratory Findings

Absolute reticulocyte count

The normal values are:

• RBC count - 5 million/microLitre
• Reticulocyte count - 0.5 -1.5 %
• Absolute reticulocyte count - 25,000 to 75,000/microLitre

Peripheral blood smear

• 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.

Liver function test

• The level of unconjugated bilirubin in the blood is elevated. This may lead to jaundice.

Other lab tests

• Elevated lactate dehydrogenase (LDH)
• Elevated haptoglobin
• The direct Coombs test is positive if hemolysis is caused by an immune process

Urinanalysis

• 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