Hemolytic anemia differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
The differential diagnosis for hemolytic anemia is broad and includes a variety of conditions that affect [[red blood cells]]. Nutritional deficiencies and [[thalassemias]] are important components of the differentiation. Certain laboratory tests and physical exam features can help to distinguish these conditions. The treatment of these conditions are quite different, so it is important to distinguish hemolytic anemia from other causes of anemia or other conditions that present similarly. | The differential diagnosis for hemolytic anemia is broad and includes a variety of conditions that affect [[red blood cells]]. [[Nutritional deficiencies]] and [[Thalassemia|thalassemias]] are important components of the differentiation. Certain laboratory tests and physical exam features can help to distinguish these conditions. The treatment of these conditions are quite different, so it is important to distinguish hemolytic anemia from other causes of [[anemia]] or other conditions that present similarly. | ||
==Differentiating Hemolytic anemia from other Diseases== | ==Differentiating Hemolytic anemia from other Diseases== | ||
Revision as of 18:45, 30 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
The differential diagnosis for hemolytic anemia is broad and includes a variety of conditions that affect red blood cells. Nutritional deficiencies and thalassemias are important components of the differentiation. Certain laboratory tests and physical exam features can help to distinguish these conditions. The treatment of these conditions are quite different, so it is important to distinguish hemolytic anemia from other causes of anemia or other conditions that present similarly.
Differentiating Hemolytic anemia from other Diseases
| Characteristic/Parameter | Hemolytic anemia | Sideroblastic anemia | Anemia of chronic disease | Thalassemia | Iron-deficiency anemia | Erythropoietin deficiency | Vitamin B12 or 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 | Genetic defect with alpha- or beta-globin production | Loss of iron from gastrointestinal blood loss or menstrual blood loss | Chronic kidney disease or other renal dysfunction | Pernicious anemia, Diphyllobothrium latum infection, nutritional deficiency, Crohn's disease of terminal ileum |
| Mean corpuscular volume | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) | Microcytic (<80 femtoliter) | Normocytic (80-100 femtoliter) | Macrocytic (>100 femtoliter) |
| 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 | Abnormal hemoglobin electrophoresis (in beta-thalassemia) | Low serum iron, elevated transferrin, low transferrin saturation, low ferritin | Low erythropoietin level | Low vitamin B12 or folate level, megaloblastic anemia and hypersegmented neutrophils |
| Physical exam | Pallor, jaundice | Pallor, weakness | Pallor, weakness | Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | Pallor, weakness, positive occult blood testing (if GI bleeding) | Pallor, weakness, signs of chronic kidney disease | Numbness, weakness, tingling, paresthesias |
| 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 | Transfusion support, iron chelation, gene therapy if available | Intravenous or oral iron supplementation | Epoetin alfa 50-100 units/kg 3 times weekly, darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks[1] | Vitamin B12 1000mcg daily, folate 1mg daily |
| Other associated abnormalities | HELLP syndrome, TTP, CLL | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | Inflammatory bowel disease | Extramedullary hematopoiesis | Chronic blood loss | Dialysis dependence, myelodysplastic syndrome | Neuropathy |
Table legend: HELLP, hemolysis/elevated liver enzymes/low platelets; TTP, thrombotic thrombocytopenia purpura; CLL, chronic lymphocytic leukemia
References
- ↑ Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J; et al. (2017). "A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes". Leukemia. 31 (9): 1944–1950. doi:10.1038/leu.2017.192. PMC 5596208. PMID 28626220.