Hemolytic anemia differential diagnosis: Difference between revisions
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! scope="row" | Etiology | ! scope="row" | Etiology | ||
| Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease | | Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease | ||
| Alcoholism, lead poisoning, vitamin B6 deficiency | | Alcoholism, lead poisoning, vitamin B6 deficiency, isoniazid, chloramphenicol | ||
| | | Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6 | ||
| [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]] | | [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]] | ||
| [[Petechiae]], [[bleeding]], other [[autoimmune diseases]] | | [[Petechiae]], [[bleeding]], other [[autoimmune diseases]] | ||
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! scope="row" | Mean corpuscular volume | ! scope="row" | Mean corpuscular volume | ||
| Normocytic (80-100 femtoliter) | | Normocytic (80-100 femtoliter) | ||
| | | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | ||
| | | Normocytic (80-100 femtoliter) | ||
| Low | | Low | ||
| Low; can be as low as 10000 per microliter | | Low; can be as low as 10000 per microliter | ||
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! scope="row" | Laboratory abnormalities | ! scope="row" | Laboratory abnormalities | ||
| Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH | | Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH | ||
| | | Ringed sideroblasts in bone marrow; low vitamin B6 level, high lead level | ||
| | | Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | ||
| Normal | | Normal | ||
| Normal | | Normal | ||
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! scope="row" | Physical exam | ! scope="row" | Physical exam | ||
| Pallor, jaundice | | Pallor, jaundice | ||
| | | Pallor, weakness | ||
| | | Pallor, weakness | ||
| Dysregulation of [[Complement|complement activation]]; mutation in [[Factor H|complement factor H]] | | Dysregulation of [[Complement|complement activation]]; mutation in [[Factor H|complement factor H]] | ||
| Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]] | | Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]] | ||
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! scope="row" | Treatment | ! scope="row" | Treatment | ||
| Removal of offending agent, steroids, alternative immunosuppression | | Removal of offending agent, steroids, alternative immunosuppression | ||
| | | Removal of offending medication, high-dose vitamin B6 (up to 200mg daily), avoidance of splenectomy, symptomatic transfusion support with iron chelation as needed | ||
| | | Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | ||
| No | | No | ||
| Yes | | Yes | ||
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! scope="row" | Other associated abnormalities | ! scope="row" | Other associated abnormalities | ||
| HELLP syndrome, TTP, CLL | | HELLP syndrome, TTP, CLL | ||
| | | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | ||
| | | Inflammatory bowel disease | ||
| Usually | | Usually | ||
| Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter | | Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter |
Revision as of 05:03, 5 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
Differentiating Hemolytic anemia from other Diseases
Characteristic/Parameter | Hemolytic anemia | Sideroblastic anemia | Anemia of chronic disease | Thalassemia | Iron-deficiency anemia | Erythropoietin deficiency | Vitamin B12 deficiency | Folate deficiency |
---|---|---|---|---|---|---|---|---|
Etiology | Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease | Alcoholism, lead poisoning, vitamin B6 deficiency, isoniazid, chloramphenicol | Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6 | Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia | Petechiae, bleeding, other autoimmune diseases | Petechiae, purpura, ecchymoses | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
Mean corpuscular volume | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | Normocytic (80-100 femtoliter) | Low | Low; can be as low as 10000 per microliter | Low; can be less than 10000 per microliter; sudden onset after transfusion | Variable; usually low | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
Laboratory abnormalities | Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH | Ringed sideroblasts in bone marrow; low vitamin B6 level, high lead level | Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | Normal | Normal | Normal | Usually normal | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
Physical exam | Pallor, jaundice | Pallor, weakness | Pallor, weakness | Dysregulation of complement activation; mutation in complement factor H | Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori | Exposure to transfused products | Autoimmunity with development of antibodies to DNA | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
Treatment | Removal of offending agent, steroids, alternative immunosuppression | Removal of offending medication, high-dose vitamin B6 (up to 200mg daily), avoidance of splenectomy, symptomatic transfusion support with iron chelation as needed | Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | No | Yes | No; transfusion-related | Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
Other associated abnormalities | HELLP syndrome, TTP, CLL | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | Inflammatory bowel disease | Usually | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Rare | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |