Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + Print Section ++ For further information, see CMDT Part 13-09: Hemolytic Anemias + Key Features Print Section ++ ++ Generally classified according to whether the defect is intrinsic or extrinsic to the red blood cell (RBC) Intrinsic Membrane defects Hereditary spherocytosis Hereditary elliptocytosis Paroxysmal nocturnal hemoglobinuria Glycolytic defects Pyruvate kinase deficiency Severe hypophosphatemia Oxidation vulnerability Glucose-6-phosphate dehydrogenase deficiency Methemoglobinemia Hemoglobinopathies Sickle cell syndromes Thalassemia Unstable hemoglobins Methemoglobinemia Extrinsic Immune Autoimmune Lymphoproliferative disease Drug-induced Microangiopathic Thrombotic thrombocytopenic purpura Hemolytic-uremic syndrome Disseminated intravascular coagulation Valve hemolysis Metastatic adenocarcinoma Vasculitis Copper overload Infection Plasmodium Clostridium Borrelia Hypersplenism Burns + Clinical Findings Print Section ++ ++ Symptoms of anemia Jaundice, pigment gallstones, cholecystitis in chronic cases Palpable spleen + Diagnosis Print Section ++ ++ Serum haptoglobin may be low but is neither specific nor sensitive Reticulocytosis present unless second disorder (infection, folate deficiency) superimposed on hemolysis Transient hemoglobinemia with intravascular hemolysis Hemoglobinuria when capacity for reabsorption of hemoglobin by renal tubular cells exceeded Urine hemosiderin test positive; indicates prior intravascular hemolysis Hemoglobinemia and methemalbuminemia if severe intravascular hemolysis Indirect bilirubin elevated, total bilirubin elevated to ≤ 4 mg/dL; higher bilirubin elevations may indicate hepatic dysfunction Serum lactate dehydrogenase elevated in microangiopathic hemolysis; may be elevated in other hemolytic anemias + Treatment Print Section ++ ++ See Treatment of specific anemias Folic acid, 1 mg orally once daily Transfusions possible