Haemolysis
Last updated: Friday, 03, December, 2010
| Causes | Appropriate Tests |
|---|---|
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. |
Severe burns | 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 | |
Hypersplenism | |
Flow cytometry evaluation. | |
Paroxysmal cold haemoglobinuria | Donath Landsteiner antibody test. |
March haemoglobinuria | 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. See also Haemoglobinopathy and Sickle cell disorders |
With red cell parasites | Parasites - blood film. |
Babesiosis |