Autoimmune hemolytic anemia differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S; Shyam Patel [2], Irfan Dotani [3]
Overview
[edit | edit source]A variety of conditions comprise the differential diagnosis of autoimmune hemolytic anemia. These include microangiopathic hemolytic anemia, paroxysmal cold hemoglobinuria, paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis, pernicious anemia, and chronic lymphocytic leukemia. The diagnosis of autoimmune hemolytic anemia can sometimes be made by first ruling out these other causes. It is important to distinguish amongst these conditions since the prognosis and treatment of each condition is different.
Differentiating Autoimmune hemolytic anemia from other Diseases
[edit | edit source]| Type of anemia | MCV | Hemolysis | Intrinsic/Extrinsic | Hb concentration | RDW | Reticulocytosis | Haptoglobin levels | Specific Symptoms | Specific History | Physical examination | Genetics | Iron studies | Specific finding on blood smear | |||||
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| Hepcidin | Serum iron | Serum Tfr level | Transferrin or TIBC | Ferritin | % Transferrin saturation | |||||||||||||
| Autoimmune hemolytic anemia |
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Associated with:
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| Iron deficiency anemia | -- | -- |
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| Lead poisoning | -- | -- |
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-- |
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| Sideroblastic anemia | -- | -- |
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| Anemia of chronic disease | -- | -- |
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| Thalassemia | -- | -- |
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Normal or ↓(Decreased)
↑(Increased) |
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α-thalassemia
β-thalassemia
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α-thalassemia
β-thalassemia
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Normal to increased |
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| G6pd deficiency |
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History of using
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| Pyruvate Kinase deficiency |
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| Sickle cell anemia |
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Normal or moderately elevated |
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Normal or moderately elevated |
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| HbC disease |
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β-globin |
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| Paroxysmal nocturnal hemoglobinuria(PNH)[1][2] |
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| Hereditary spherocytosis |
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area and no central pallor ( MCHC) | ||||
| Microangiopathic hemolytic anemia[3] |
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Associated with
syndrome
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| Macroangiopathic hemolytic anemia |
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Associated with
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| Infections |
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Associated with
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| Iron deficiency anemia(Early) | -- | -- |
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| Anemia of chronic disease | -- | -- |
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Normal or ↓(Decreased) |
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| Aplastic anemia | -- | -- |
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| Chronic kidney disease | -- | -- |
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Normal /↑(Increased) |
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| Folate deficiency | -- | -- |
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| Vitamin B12 deficiency | -- | -- |
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| Orotic aciduria | -- | -- |
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| Fanconi anemia | -- | -- |
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| Diamond-Blackfan anemia | -- | -- |
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Mutations in:
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| Liver disease | -- | -- |
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| Alcoholism | -- | -- |
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| Characteristic | Causes | Pathophysiology | Laboratory abnormalities | Physical examination | Therapy | Other associations |
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| Autoimmune hemolytic anemia |
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| Microangiopathic hemolytic anemia |
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| Paroxysmal cold hemoglobinuria |
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| Paroxysmal nocturnal hemoglobinuria |
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| Hereditary spherocytosis[6] |
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| Pernicious anemia[7] |
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| Chronic lymphocytic leukemia[8] |
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References
[edit | edit source]- ↑ Bunyaratvej A, Butthep P (January 1992). "Cytometric analysis of paroxysmal nocturnal hemoglobinuria erythrocytes". J Med Assoc Thai. 75 Suppl 1: 237–42. PMID 1402472.
- ↑ Kahng J, Kim Y, Kim JO, Koh K, Lee JW, Han K (January 2015). "A novel marker for screening paroxysmal nocturnal hemoglobinuria using routine complete blood count and cell population data". Ann Lab Med. 35 (1): 35–40. doi:10.3343/alm.2015.35.1.35. PMC 4272963. PMID 25553278.
- ↑ Morishita E (July 2015). "[Diagnosis and treatment of microangiopathic hemolytic anemia]". Rinsho Ketsueki (in Japanese). 56 (7): 795–806. doi:10.11406/rinketsu.56.795. PMID 26251142.
- ↑ 4.0 4.1 4.2 Berentsen S, Sundic T (2015). "Red blood cell destruction in autoimmune hemolytic anemia: role of complement and potential new targets for therapy". Biomed Res Int. 2015: 363278. doi:10.1155/2015/363278. PMC 4326213. PMID 25705656.
- ↑ 5.0 5.1 5.2 5.3 Akpoguma AO, Carlisle TL, Lentz SR (2015). "Case report: paroxysmal cold hemoglobinuria presenting during pregnancy". BMC Hematol. 15: 3. doi:10.1186/s12878-015-0023-7. PMC 4334594. PMID 25699184.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Gallagher PG (2013). "Abnormalities of the erythrocyte membrane". Pediatr Clin North Am. 60 (6): 1349–62. doi:10.1016/j.pcl.2013.09.001. PMC 4155395. PMID 24237975.
- ↑ 7.0 7.1 7.2 7.3 7.4 Chan CQ, Low LL, Lee KH (2016). "Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia". Front Med (Lausanne). 3: 38. doi:10.3389/fmed.2016.00038. PMC 4993789. PMID 27602354.
- ↑ Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG; et al. (2017). "Chronic lymphocytic leukaemia". Nat Rev Dis Primers. 3: 16096. doi:10.1038/nrdp.2016.96. PMC 5336551. PMID 28102226.
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