Hemolytic anemia - Chronic
Definition
Shortened RBC survival in the peripheral blood before the normal life span of 120 days, manifested as anemia when RBC production is unable to match the rate of RBC destruction
Findings
* Pallor
* Jaundice
* Dyspnea - Chronic
* Tachycardia
* Oliguria and anuria
* Urine looks dark
* Fatigue
* Pain
* Seizure
Tests
Suspected hemolytic anemia
* Complete blood count with white cell differential, automated
Suspected hemolytic anemia
* Reticulocyte count
Suspected hemolytic anemia
* Peripheral blood smear interpretation
Suspected hemolytic anemia
* Plasma unconjugated bilirubin measurement
* LDH blood measurement
* Measurement of total hemoglobin concentration in urine specimen
Suspected hemolytic anemia
* Iron measurement, urine
Suspected hemolytic anemia
* Serum haptoglobin measurement: Low serum haptoglobin levels occur in both intravascular and extravascular hemolytic anemia .
Suspected immune hemolytic anemia
* Direct Coombs test
Suspected hemoglobinopathy
* Hemoglobin electrophoresis
Differential Diagnosis
* Sickle cell anemia - Chronic
* Thalassemia - Chronic
* Hemolytic disease of fetus OR newborn due to isoimmunization
* Warm autoimmune hemolytic anemia
* Cold autoimmune hemolytic anemia
* Disseminated intravascular coagulation
* Hemolytic uremic syndrome
* Thrombotic thrombocytopenic purpura
* Hereditary spherocytosis
* Hereditary elliptocytosis
* Deficiency of pyruvate kinase
* Deficiency of glucose-6-phosphate dehydrogenase
* Transfusion reaction due to isoantibody
* Drug-induced immune hemolytic anemia
* Traumatic cardiac hemolytic anemia
* Paroxysmal nocturnal hemoglobinuria
* Paroxysmal cold hemoglobinuria
Treatment
Drug Therapy
Chronic hemolysis in patients with hemolytic anemia
FOLIC ACID
Adults: Up to 1 mg/day orally, IM, or IV; maintenance dose 0.4 mg/day orally
Adults (pregnant and lactating women): 0.8 mg/day orally
Warm autoimmune hemolytic anemia
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