In this section : Haematology and Thrombosis
Myeloma
Warfarin
Anticoagulation for AF, DVT and PE
Orthopaedic VTE Risk Assessment
Haemolytic Anaemia
Platelet Transfusion
Parenteral Iron in Adults >18 Years
Pulmonary Embolism
Deep Vein Thrombosis of Lower Extremities
Bleeding with Other Antithrombotics
Low Molecular Weight Heparin
Haematinic Testing
Thromboprophylaxis for Non-Covid Patients
Thrombophilia Screening
Antithrombotics in Hip Fracture
Reversal of Warfarin
Lumbar Puncture, Antiplatelet & Anticoagulant Drugs
Antithrombotics & Surgery
Iron Deficiency Anaemia
Unfractionated Heparin Infusion
Massive Pulmonary Embolism
Haemolytic Anaemia
Last updated 7th March 2022
Making a Diagnosis
- Evidence of red cell destruction – raised unconjugated bilirubin, raised LDH, reduced haptoglobin (if intravascular haemolysis)
- Evidence of compensatory increased red cell production – raised retics
- Features suggestive of cause – Direct Antiglobulin Test (Coombs test) (detects IgG or complement attached to red cell surface and suggests immune haemolytic if positive), blood film (eg red cell fragments in malignant hypertension, spherocytes in hereditary spherocytosis)
- Classic triad of haemolytic anaemia is anaemia with jaundice and splenomegaly, but not always present
Causes
- Mechanisms either increased fragility of the red cell (e.g. membraneopathies), increased predisposition to oxidative red cell damage (e.g. G-6-PD deficiency, PK deficiency), physical damage (DIC, heart valves, burns) or immune mediated damage.
- Can be hereditary or acquired
- Hereditary causes include hereditary spherocytosis, haemoglobinopathies, G6PD deficiency
- Acquired may be immune or non-immune
- Immune often associated with lymphoma, CLL, SLE and certain drugs
- Non-immune causes include malignant HT, HUS, TTP, prosthetic heart valves and certain drugs
Differentiating From Iron Deficient Anaemia
Haemolytic | Iron Deficiency | |
---|---|---|
MCV | >80 | <80 |
Blood Film | May suggest cause eg spherocytes in hereditary spherocytosis, red cell fragments in malignant HT | Should show hypochronic microcytic red cells |
Bilirubin | Raised | Normal |
Haptoglobin | Reduced | Normal |
LDH | Raised | Normal |
Retics | Raised | Normal (but may be raised if acute blood loss) |
Ferritin | Normal | Low (providing CRP also low) |
DAT | Positive if immune cause | Negative |
Management
- Discuss all cases with haematology
- Folic acid 5mg orally once daily is required to supply increased RBC production
- Supportive care and removal of any offending agent are the mainstays of therapy.
- Packed RBC transfusion should be restricted to symptomatic anaemia. Absolute Hb threshold varies with age and comorbidities, from Hb 60 g/L or below for a young patient to Hb 100 g/L or below for an older adult with heart disease.
- Prednisolone 1mg/kg daily usually recommended for autoimmune haemolytic anaemia
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Content updated by Dr Ranjit Thomas