Hemolytic anemia differential diagnosis: Difference between revisions
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other associated abnormalities | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other associated abnormalities | ||
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|Hemolytic anemia | ! align="center" style="background:#DCDCDC;" |Hemolytic anemia | ||
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* [[Drug-induced]] | * [[Drug-induced]] | ||
* [[Immune-mediated disease|Immune-mediated]] | * [[Immune-mediated disease|Immune-mediated]] | ||
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* [[Infections]] | * [[Infections]] | ||
* [[Rheumatologic disease]] | * [[Rheumatologic disease]] | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Jaundice]] | * [[Jaundice]] | ||
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* [[Normocytic anemia|Normocytic]] | * [[Normocytic anemia|Normocytic]] | ||
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* Indirect [[hyperbilirubinemia]] | * Indirect [[hyperbilirubinemia]] | ||
* [[Reticulocytosis]] | * [[Reticulocytosis]] | ||
* Low [[haptoglobin]] | * Low [[haptoglobin]] | ||
* Elevated [[LDH]] | * Elevated [[LDH]] | ||
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* Removal of offending agent | * Removal of offending agent | ||
* [[Steroids]] | * [[Steroids]] | ||
* Alternative [[immunosuppression]] | * Alternative [[immunosuppression]] | ||
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* [[HELLP syndrome]] | * [[HELLP syndrome]] | ||
* [[TTP]] | * [[TTP]] | ||
* [[Chronic lymphocytic leukemia|CLL]] | * [[Chronic lymphocytic leukemia|CLL]] | ||
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|[[Sideroblastic anemia]] | ! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]] | ||
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* [[Alcoholism]] | * [[Alcoholism]] | ||
* [[Lead poisoning]] | * [[Lead poisoning]] | ||
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* [[Isoniazid]] | * [[Isoniazid]] | ||
* [[Chloramphenicol]] | * [[Chloramphenicol]] | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Muscle weakness|Weakness]] | * [[Muscle weakness|Weakness]] | ||
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* [[Microcytic anemia|Microcytic]] | * [[Microcytic anemia|Microcytic]] | ||
* [[Normocytic anemia|Normocytic]] | * [[Normocytic anemia|Normocytic]] | ||
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* Ringed sideroblasts in [[bone marrow]] | * Ringed sideroblasts in [[bone marrow]] | ||
* Low [[vitamin B6]] level | * Low [[vitamin B6]] level | ||
* High [[lead]] level | * High [[lead]] level | ||
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* Removal of offending [[medication]] | * Removal of offending [[medication]] | ||
* High-dose [[vitamin B6]] (up to 200mg daily) | * High-dose [[vitamin B6]] (up to 200mg daily) | ||
* Avoidance of [[splenectomy]] | * Avoidance of [[splenectomy]] | ||
* Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed | * Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed | ||
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* [[Myelodysplastic syndrome]] | * [[Myelodysplastic syndrome]] | ||
* [[Myeloproliferative neoplasm]] | * [[Myeloproliferative neoplasm]] | ||
* [[Iron overload]] | * [[Iron overload]] | ||
|- | |- | ||
|[[Anemia of chronic disease]] | ! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]] | ||
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* [[Chronic kidney disease]] | * [[Chronic kidney disease]] | ||
* [[Rheumatologic disease]] | * [[Rheumatologic disease]] | ||
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* [[HIV]] | * [[HIV]] | ||
* Chronic infection; excess release of [[IL-1]] and [[IL-6]] | * Chronic infection; excess release of [[IL-1]] and [[IL-6]] | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Weakness]] | * [[Weakness]] | ||
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* [[Normocytic anemia|Normocytic]] | * [[Normocytic anemia|Normocytic]] | ||
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* Elevated [[ESR]] and [[CRP]] | * Elevated [[ESR]] and [[CRP]] | ||
* Elevated [[hepcidin]] | * Elevated [[hepcidin]] | ||
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* Low [[transferrin]] | * Low [[transferrin]] | ||
* Elevated [[ferritin]] | * Elevated [[ferritin]] | ||
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* Treatment of the underlying cause; [[erythropoiesis]]-stimulating agents | * Treatment of the underlying cause; [[erythropoiesis]]-stimulating agents | ||
* Supportive [[Red blood cell transfusion|red blood cell transfusions]] | * Supportive [[Red blood cell transfusion|red blood cell transfusions]] | ||
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* [[Inflammatory bowel disease]] | * [[Inflammatory bowel disease]] | ||
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|[[Thalassemia]] | ! align="center" style="background:#DCDCDC;" |[[Thalassemia]] | ||
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* [[Genetic defect]] with alpha- or [[beta-globin]] production | * [[Genetic defect]] with alpha- or [[beta-globin]] production | ||
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* [[Irritability]] | * [[Irritability]] | ||
* [[Growth retardation]] | * [[Growth retardation]] | ||
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* [[Hepatomegaly]] | * [[Hepatomegaly]] | ||
* [[Splenomegaly]] | * [[Splenomegaly]] | ||
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* [[Microcytic]] | * [[Microcytic]] | ||
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* Abnormal [[hemoglobin]] [[electrophoresis]] (in [[beta-thalassemia]]) | * Abnormal [[hemoglobin]] [[electrophoresis]] (in [[beta-thalassemia]]) | ||
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* [[Blood transfusion|Transfusion]] support | * [[Blood transfusion|Transfusion]] support | ||
* [[Iron]] chelation | * [[Iron]] chelation | ||
* [[Gene therapy]] if available | * [[Gene therapy]] if available | ||
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* [[Extramedullary hematopoiesis]] | * [[Extramedullary hematopoiesis]] | ||
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|[[Iron deficiency anemia]] | ! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]] | ||
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* Loss of [[iron]] from [[gastrointestinal]] blood loss or [[menstrual]] [[blood loss]] | * Loss of [[iron]] from [[gastrointestinal]] blood loss or [[menstrual]] [[blood loss]] | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Weakness]] | * [[Weakness]] | ||
* Positive [[occult blood]] testing (if [[Gastrointestinal bleeding|GI bleeding]]) | * Positive [[occult blood]] testing (if [[Gastrointestinal bleeding|GI bleeding]]) | ||
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* [[Microcytic]] | * [[Microcytic]] | ||
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* Low serum [[iron]] | * Low serum [[iron]] | ||
* Elevated [[transferrin]] | * Elevated [[transferrin]] | ||
* Low [[transferrin saturation]] | * Low [[transferrin saturation]] | ||
* Low [[ferritin]] | * Low [[ferritin]] | ||
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* Intravenous or oral iron supplementation | * Intravenous or oral iron supplementation | ||
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* [[Blood loss|Chronic blood loss]] | * [[Blood loss|Chronic blood loss]] | ||
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|[[Erythropoietin]] deficiency | ! align="center" style="background:#DCDCDC;" |[[Erythropoietin]] deficiency | ||
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* [[Chronic kidney disease]] or other [[renal dysfunction]] | * [[Chronic kidney disease]] or other [[renal dysfunction]] | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Weakness]] | * [[Weakness]] | ||
* Signs of [[chronic kidney disease]] | * Signs of [[chronic kidney disease]] | ||
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* [[Normocytic anemia|Normocytic]] | * [[Normocytic anemia|Normocytic]] | ||
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* Low [[Erythropoietin|erythropoietin level]] | * Low [[Erythropoietin|erythropoietin level]] | ||
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* [[Epoetin alfa]] 50-100 units/kg 3 times weekly | * [[Epoetin alfa]] 50-100 units/kg 3 times weekly | ||
* Darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks<ref name="pmid28626220">{{cite journal| author=Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J et al.| title=A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. | journal=Leukemia | year= 2017 | volume= 31 | issue= 9 | pages= 1944-1950 | pmid=28626220 | doi=10.1038/leu.2017.192 | pmc=5596208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28626220 }} </ref> | * Darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks<ref name="pmid28626220">{{cite journal| author=Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J et al.| title=A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. | journal=Leukemia | year= 2017 | volume= 31 | issue= 9 | pages= 1944-1950 | pmid=28626220 | doi=10.1038/leu.2017.192 | pmc=5596208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28626220 }} </ref> | ||
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* [[Dialysis]] dependence | * [[Dialysis]] dependence | ||
* [[Myelodysplastic syndrome]] | * [[Myelodysplastic syndrome]] | ||
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|[[Vitamin B12 deficiency|Vitamin B12]] or [[folate deficiency]] | ! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency|Vitamin B12]] or [[folate deficiency]] | ||
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* [[Pernicious anemia]] | * [[Pernicious anemia]] | ||
* [[Diphyllobothrium latum infection]] | * [[Diphyllobothrium latum infection]] | ||
* [[Nutritional deficiency]] | * [[Nutritional deficiency]] | ||
* [[Crohn's disease|Crohn's disease of terminal ileum]] | * [[Crohn's disease|Crohn's disease of terminal ileum]] | ||
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* [[Numbness]] | * [[Numbness]] | ||
* [[Weakness]] | * [[Weakness]] | ||
* [[Tingling]] | * [[Tingling]] | ||
* [[Paresthesias]] | * [[Paresthesias]] | ||
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* [[Macrocytic anemia|Macrocytic]] | * [[Macrocytic anemia|Macrocytic]] | ||
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* Low vitamin B12 or folate level | * Low vitamin B12 or folate level | ||
* [[Megaloblastic anemia]] with hypersegmented [[neutrophils]] | * [[Megaloblastic anemia]] with hypersegmented [[neutrophils]] | ||
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* [[Vitamin B12]] 1000mcg daily | * [[Vitamin B12]] 1000mcg daily | ||
* [[Folate]] 1mg daily | * [[Folate]] 1mg daily | ||
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* [[Neuropathy]] | * [[Neuropathy]] | ||
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Revision as of 17:19, 5 October 2018
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Hemolytic anemia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hemolytic anemia differential diagnosis On the Web |
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American Roentgen Ray Society Images of Hemolytic anemia differential diagnosis |
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Risk calculators and risk factors for Hemolytic anemia differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: 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
| Characterisitc/Parameter | Etiology | Physical examination | Mean corpuscular volume | Laboratory abnormalities | Treatment | Other associated abnormalities |
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| Hemolytic anemia |
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| Sideroblastic anemia |
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| Anemia of chronic disease |
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| Thalassemia |
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| Iron deficiency anemia |
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| Erythropoietin deficiency |
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| Vitamin B12 or folate deficiency |
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Table legend: HELLP, hemolysis/elevated liver enzymes/low platelets; TTP, thrombotic thrombocytopenic 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.