Anemia, Hemolytic

Generally classified according to whether the defect is intrinsic or extrinsic to the red blood cell (RBC)

Intrinsic defects have been described in all components of the red blood cell, including the membrane, enzyme systems, and hemoglobin; most of these disorders are hereditary

External factors are immune and microangiopathic hemolytic anemias and infections of red blood cells

Symptoms of anemia

Jaundice, pigment gallstones, cholecystitis in chronic cases

Palpable spleen

Serum haptoglobin may be low but is neither specific nor sensitive

Reticulocytosis present unless second disorder (infection, folate deficiency) superimposed on hemolysis

Transient hemoglobinemia occurs with intravascular hemolysis

Hemoglobinuria occurs when capacity for reabsorption of hemoglobin by renal tubular cells exceeded

Positive urine hemosiderin test indicates prior intravascular hemolysis

Hemoglobinemia and methemalbuminemia occur with severe intravascular hemolysis

Indirect bilirubin elevated, total bilirubin elevated to ≤ 4 mg/dL; higher bilirubin elevations may indicate hepatic dysfunction

Serum lactate dehydrogenase is elevated in microangiopathic hemolysis; may be elevated in other hemolytic anemias

See Treatment of specific anemias

Folic acid, 1 mg orally once daily

Transfusions possible