Last updated: Friday, 03, December, 2010
FBC, blood film, reticulocyte count; bilirubin, LD; haptoglobin may be useful for documentation and monitoring.
If acute intra-vascular haemolysis suspected: Schumm's test; haemoglobin - urine.
If chronic intravascular haemolysis suspected: haemosiderin - urine.
Active haemolysis may be present without anaemia if bone marrow reserve is sufficient.See also Haemolysis-Neonatal
With red cell spherocytosis
Direct antiglobulin test.
Further investigation - consult pathologist.
Autoimmune haemolysis, including
See Immediate and delayed transfusion reactions under Blood transfusion - complications.
Blood film may also show red cell fragmentation.
Clostridium perfringens septicaemia
With red cell fragmentation ± spherocytosis
Drug-induced oxidative haemolysis, especially
Heinz body preparation ± methaemoglobin, sulphaemoglobin.
Consider possibility of underlying intrinsic red cell defect.
Particularly in patients with G-6-PD deficiency.
Intrinsic red cell defects, especially
Unstable haemoglobin screening test, haemoglobin electrophoresis.
Pyruvate kinase - red cell assay.
Autohaemolysis test, further investigation in specialised laboratory.
With sickle cells
With normal red cell morphology
Flow cytometry evaluation.
Paroxysmal cold haemoglobinuria
Donath Landsteiner antibody test.
Haemoglobin - urine, after exercise.
Intrinsic red cell defects
Red cell morphology may be unremarkable in patients with sickle cell trait, G-6-PD deficiency or an unstable haemoglobinopathy, particularly when haemolysis is not active.
With red cell parasites
Parasites - blood film.