Hemolytic anemia

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This editable Main Article is under development and subject to a disclaimer.

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In hematology, Hemolytic anemia is an "A condition of inadequate circulating red blood cells (anemia) or insufficient hemoglobin due to premature destruction of red blood cells (erythrocytes)."[1]

## Classification[edit]

One classification is based on whether hemolysis occurs intravascularly or extravascularly. Another classification is whether the erythrocytes are intrinsically normal:[2]

Hemolytic anemia associated with normal red cells

* Autoimmune hemolytic anemia
* Direct antiglobulin ("Coombs") test-negative
* Direct antiglobulin ("Coombs") test-positive
* Cold agglutinin disease[3]
* Complement-induced lysis
* Microangiopathic hemolytic anemia. Includes Thrombotic thrombocytopenic purpura.
* Others

Hemolytic anemia associated with abnormal red cells

* Hemoglobinopathies. Includes Sickle cell anemia.
* Metabolic deficiency
* Erythrocyte membrane abnormality. Includes Hereditary spherocytosis.
* Others

## Diagnosis[edit]

Hemolysis

* Haptoglobin's role in diagnosis has been reviewed.[4][5] Its accuracy is:[6]
* Sensitivity 83%
* Specificity 96%
* Lactate dehydrogenase
* Bilirubin may not be very sensitive.[7]
* Reticulocyte count[8]
* Peripheral smear[9]

Autoimmunity:

* Red-blood-cell-bound immunoglobulin G[10]
* Coombs' test, using the direct method, may have 97% sensitivity for detecting warm antibodies.[11][12]

Microangiopathic hemolytic anemia

* Platelet count
* ADAMTS13 protein activity and inhibitor (von Willebrand factor-degrading protease)[13]

## References[edit]

1. ↑ Anonymous (2025), Hemolytic anemia (English). Medical Subject Headings. U.S. National Library of Medicine.
2. ↑ Wright DE, Rosovsky RP, Platt MY (2013). "Case records of the Massachusetts General Hospital. Case 36-2013. A 38-year-old woman with anemia and thrombocytopenia.". N Engl J Med 369 (21): 2032-43. DOI:10.1056/NEJMcpc1215972. PMID 24256382. Research Blogging.
3. ↑ Berentsen S, Tjønnfjord GE (2012). "Diagnosis and treatment of cold agglutinin mediated autoimmune hemolytic anemia.". Blood Rev 26 (3): 107-15. DOI:10.1016/j.blre.2012.01.002. PMID 22330255. Research Blogging.
4. ↑ Shih AW, McFarlane A, Verhovsek M (2014). "Haptoglobin testing in hemolysis: measurement and interpretation.". Am J Hematol 89 (4): 443-7. PMID 24809098. [e]
5. ↑ Rice L (1980). "Serum haptoglobin in hemolytic disease.". JAMA 244 (23): 2607-8. PMID 7431603. [e]
6. ↑ Marchand A, Galen RS, Van Lente F (1980). "The predictive value of serum haptoglobin in hemolytic disease.". JAMA 243 (19): 1909-11. PMID 7365971. [e]
7. ↑ Pirofsky B. Autoimmunization and the autoimmune hemolytic anemias. Baltimore; Williams & Wilkins: 1969:44-72
8. ↑ Liesveld JL, Rowe JM, Lichtman MA (1987). "Variability of the erythropoietic response in autoimmune hemolytic anemia: analysis of 109 cases.". Blood 69 (3): 820-6. PMID 3814817. [e]
9. ↑ Bain BJ (2005). "Diagnosis from the blood smear.". N Engl J Med 353 (5): 498-507. DOI:10.1056/NEJMra043442. PMID 16079373. Research Blogging.
10. ↑ Kamesaki T, Oyamada T, Omine M, Ozawa K, Kajii E (2009). "Cut-off value of red-blood-cell-bound IgG for the diagnosis of Coombs-negative autoimmune hemolytic anemia.". Am J Hematol 84 (2): 98-101. DOI:10.1002/ajh.21336. PMID 19105232. Research Blogging.
11. ↑ Worlledge SM, Blajchman MA (1972). "The autoimmune haemolytic anaemias.". Br J Haematol 23: Suppl:61-9. PMID 4567200. [e]
12. ↑ Allgood JW, Chaplin H (1967). "Idiopathic acquired autoimmune hemolytic anemia. A review of forty-seven cases treated from 1955 through 1965.". Am J Med 43 (2): 254-73. PMID 6034957. [e]
13. ↑ Kremer Hovinga JA, Vesely SK, Terrell DR, Lämmle B, George JN (2010). "Survival and relapse in patients with thrombotic thrombocytopenic purpura.". Blood 115 (8): 1500-11; quiz 1662. DOI:10.1182/blood-2009-09-243790. PMID 20032506. Research Blogging.