Hemolytic anemia resident survival guide

Hemolytic anemia Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

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

Overview

• Anemia is defined as a decrease in red blood cell population in the body.
• Hemolytic anemia results from a destruction of RBCs which is faster than the bone marrow production of them. Hemolysis can be due to either extravascular or intravascular destruction of cells.
• It is caused due to a wide variety of reasons which include inherited diseases like thalassemia, sickle cell disease etc, infections, autoimmune conditions, bone marrow dysfunction, blood transfusions and certain drugs can also result in hemolytic anemia .
• Most common presenting symptoms are fatigue, palpitations, dyspnea, tachycardia and icterus in severe cases.
• Diagnosis usually requires a battery of tests including, but not limited to a peripheral smear, CBC, serum LDH, bone marrow studies, etc.
• Treatment is directed by the specific cause and can involve bone marrow transplant, splenectomy, transfusions etc.

Causes

• Intraerythrocytic causes

1. Membrane cytoskeletal defects
   • Hereditary spherocytosis
   • Hereditary stomatocytosis
   • Hereditary elliptocytosis
   • Hereditary pyropoikilocytosis
2. Enzyme defects
   • Glucose 6 phosphate deficiency
   • Pyruvate kinase deficiency
3. Hemoglobinopathies
   • Sickle cell disease
   • Thalassemia
   • Congenital dyserythropoietic anemia
4. Paroxysmal nocturnal hemoglobinuria

• Extraerythrocytic causes
  • Immune causes

1. Autoimmune hemolytic anemia
   • Warm agglutinin disease
   • Cold agglutinin disease
2. Isoimmune hemolytic anemia
   • ABO group incompatible blood transfusion
   • Rhesus group incompatible blood transfusion
3. Drug induced hemolytic anemia
   • Cephalosporins (most common)
   • Penicillin
   • Dapsone
   • Methyldopa
   • NSAIDs
   • Nitrofurantoin etc

• • Non-immune causes

1. Microangiopathic hemolytic anemia
   • Hemolytic uremic syndrome
   • Thrombotic thrombocytopenia purpura
   • Systemic lupus erythematosus
   • Disseminated intravascular coagulation
2. Macroangiopathic hemolytic anemia
   • Prosthetic heart valves
   • Aortic stenosis
   • Malignant hypertension
   • Pre-eclampsia
   • Dialysis
   • Exertional hemolysis eg., during exercise
3. Infections/ Toxins
   • Malaria
   • Bartonella
   • Hepatitis
   • CMV
   • Hemotoxic snake bite venom
4. Hypersplenism
5. Liver disease

FIRE

Diagnosis

Treatment

Do's

Don'ts

References