Hemolytic anemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]


Laboratory evaluation begins with examination of the peripheral blood smear. Serum tests include LDH, haptoglobin, bilirubin, and reticulocyte count. A combination of all of these tests can give insight into whether or note hemolytic anemia is present and, if present, the degree of hemolysis. The osmotic fragility test is less commonly used but can also be used to assess for predisposition to hemolysis.

Approach to diagnosis of hemolytic anemia

The most important initial diagnostic tests is the peripheral blood smear. This allows for direct visualization of the red blood cells and any other morphologic abnormalities. The results of the peripheral blood smear can frequently guide additional testing.[1] The cost of a peripheral blood smear is low, and thus it is the test of choice for initial workup of hemolytic anemia. A peripheral blood smear is prepared by placing a small about of whole blood onto a glass slide, then using a second glass slide to smear the blood on the first slide. Stains are done to help visualize cells.

Peripheral blood smear

Laboratory Findings

Specific findings for intravascular hemolysis

Specific findings for extravascular hemolysis

  • Spherocytic red cell morphology
  • Negative urine hemosiderin
  • Negative urine hemoglobin

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