Hemolytic anemia differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(5 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Hemolytic anemia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hemolytic_anemia]]
{{CMG}} {{shyam}}
{{CMG}}; {{AE}} {{shyam}}


==Overview==
==Overview==
Line 8: Line 8:
==Differentiating Hemolytic anemia from other Diseases==
==Differentiating Hemolytic anemia from other Diseases==


{| class="wikitable"
{|
! scope="col" | Characteristic/Parameter
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Characterisitc/Parameter
! scope="col" | '''Hemolytic anemia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! scope="col" | '''Sideroblastic anemia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! scope="col" | '''Anemia of chronic disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mean corpuscular volume
! scope="col" | '''Thalassemia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Laboratory abnormalities
! scope="col" | '''Iron-deficiency anemia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Treatment
! scope="col" | '''Erythropoietin deficiency'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other associated abnormalities
! scope="col" | '''Vitamin B12 or folate deficiency'''
|-
|-
! scope="row" | Etiology
! align="center" style="background:#DCDCDC;" |Hemolytic anemia<ref name="pmid26447931">{{cite journal |vauthors=Hill QA |title=Autoimmune hemolytic anemia |journal=Hematology |volume=20 |issue=9 |pages=553–4 |date=October 2015 |pmid=26447931 |doi=10.1179/1024533215Z.000000000401 |url=}}</ref>
| Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease
| align="left" style="background:#F5F5F5;" |  
| Alcoholism, lead poisoning, vitamin B6 deficiency, isoniazid, chloramphenicol
| Chronic kidney disease, rheumatologic disease, cancer, HIV, chronic infection; excess release of IL-1 and IL-6
| Genetic defect with alpha- or beta-globin production
| Loss of iron from gastrointestinal blood loss or menstrual blood loss
| Chronic kidney disease or other renal dysfunction
| Pernicious anemia, Diphyllobothrium latum infection, nutritional deficiency, Crohn's disease of terminal ileum
|-
! scope="row" | Mean corpuscular volume
| Normocytic (80-100 femtoliter)
| Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter)
| Normocytic (80-100 femtoliter)
| Microcytic (<80 femtoliter)
| Microcytic (<80 femtoliter)
| Normocytic (80-100 femtoliter)
| Macrocytic (>100 femtoliter)
|-
! scope="row" | Laboratory abnormalities
| Indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, elevated LDH
| Ringed sideroblasts in bone marrow; low vitamin B6 level, high lead level
| Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin
| Abnormal hemoglobin electrophoresis (in beta-thalassemia)
| Low serum iron, elevated transferrin, low transferrin saturation, low ferritin
| Low erythropoietin level
| Low vitamin B12 or folate level, megaloblastic anemia and hypersegmented neutrophils
|-
! scope="row" | Physical exam
| Pallor, jaundice
| Pallor, weakness
| Pallor, weakness
| Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly
| Pallor, weakness, positive occult blood testing (if GI bleeding)
| Pallor, weakness, signs of chronic kidney disease
| Numbness, weakness, tingling, paresthesias
|-
! scope="row" | Treatment
| Removal of offending agent, steroids, alternative immunosuppression
| Removal of offending medication, high-dose vitamin B6 (up to 200mg daily), avoidance of splenectomy, symptomatic transfusion support with iron chelation as needed
| Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions
| Transfusion support, iron chelation, gene therapy if available
| Intravenous or oral iron supplementation
| Epoetin alfa 50-100 units/kg 3 times weekly, darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks
| Vitamin B12 1000mcg daily, folate 1mg daily
|-
! scope="row" | Other associated abnormalities
| HELLP syndrome, TTP, CLL
| Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload
| Inflammatory bowel disease
| Extramedullary hematopoiesis
| Chronic blood loss
| Dialysis dependence, myelodysplastic syndrome
| Neuropathy
|}
 
{| class="wikitable"
!Characterisitc/Parameter
!Etiology
!Mean corpuscular volume
!Laboratory abnormalities
!Physical examination
!Treatment
!Other associated abnormalities
|-
|Hemolytic anemia
|
* [[Drug-induced]]
* [[Drug-induced]]
* [[Immune-mediated disease|Immune-mediated]]  
* [[Immune-mediated disease|Immune-mediated]]  
Line 89: Line 24:
* [[Infections]]
* [[Infections]]
* [[Rheumatologic disease]]
* [[Rheumatologic disease]]
|
| align="left" style="background:#F5F5F5;" |
* [[Normocytic anemia|Normocytic]] (80-100 femtoliter)
* [[Pallor]]
|
* [[Jaundice]]
| align="left" style="background:#F5F5F5;" |  
* [[Normocytic anemia|Normocytic]]
| align="left" style="background:#F5F5F5;" |  
* Indirect [[hyperbilirubinemia]]  
* Indirect [[hyperbilirubinemia]]  
* [[Reticulocytosis]]  
* [[Reticulocytosis]]  
* Low [[haptoglobin]]
* Low [[haptoglobin]]
* Elevated [[LDH]]
* Elevated [[LDH]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Pallor]]
* [[Jaundice]]
|
* Removal of offending agent
* Removal of offending agent
* [[Steroids]]
* [[Steroids]]
* Alternative [[immunosuppression]]
* Alternative [[immunosuppression]]
|
| align="left" style="background:#F5F5F5;" |  
* [[HELLP syndrome]]
* [[HELLP syndrome]]
* [[TTP]]
* [[TTP]]
* [[Chronic lymphocytic leukemia|CLL]]
* [[Chronic lymphocytic leukemia|CLL]]
|-
|-
|[[Sideroblastic anemia]]  
! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]]<ref name="pmid25064706">{{cite journal |vauthors=Bottomley SS, Fleming MD |title=Sideroblastic anemia: diagnosis and management |journal=Hematol. Oncol. Clin. North Am. |volume=28 |issue=4 |pages=653–70, v |date=August 2014 |pmid=25064706 |doi=10.1016/j.hoc.2014.04.008 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Alcoholism]]  
* [[Alcoholism]]  
* [[Lead poisoning]]
* [[Lead poisoning]]
Line 115: Line 50:
* [[Isoniazid]]  
* [[Isoniazid]]  
* [[Chloramphenicol]]
* [[Chloramphenicol]]
|
| align="left" style="background:#F5F5F5;" |
* [[Microcytic anemia|Microcytic]] (<80 femtoliter)
* [[Pallor]]
Or
* [[Muscle weakness|Weakness]]
* [[Normocytic anemia|Normocytic]] (80-100 femtoliter)
| align="left" style="background:#F5F5F5;" |  
|
* [[Microcytic anemia|Microcytic]]  
* [[Normocytic anemia|Normocytic]]
| align="left" style="background:#F5F5F5;" |  
* Ringed sideroblasts in [[bone marrow]]  
* Ringed sideroblasts in [[bone marrow]]  
* Low [[vitamin B6]] level
* Low [[vitamin B6]] level
* High [[lead]] level
* High [[lead]] level
|
| align="left" style="background:#F5F5F5;" |  
* [[Pallor]]
 
* [[Muscle weakness|Weakness]]
|
* Removal of offending [[medication]]
* Removal of offending [[medication]]
* High-dose [[vitamin B6]] (up to 200mg daily)
* High-dose [[vitamin B6]] (up to 200mg daily)
* Avoidance of [[splenectomy]]
* Avoidance of [[splenectomy]]
* Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed
* Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed
|
| align="left" style="background:#F5F5F5;" |  
* [[Myelodysplastic syndrome]]  
* [[Myelodysplastic syndrome]]  
* [[Myeloproliferative neoplasm]]
* [[Myeloproliferative neoplasm]]
* [[Iron overload]]
* [[Iron overload]]
|-
|-
|[[Anemia of chronic disease]]  
! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]]<ref name="pmid21239806">{{cite journal |vauthors=Roy CN |title=Anemia of inflammation |journal=Hematology Am Soc Hematol Educ Program |volume=2010 |issue= |pages=276–80 |date=2010 |pmid=21239806 |doi=10.1182/asheducation-2010.1.276 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Chronic kidney disease]]  
* [[Chronic kidney disease]]  
* [[Rheumatologic disease]]  
* [[Rheumatologic disease]]  
Line 144: Line 77:
* [[HIV]]  
* [[HIV]]  
* Chronic infection; excess release of [[IL-1]] and [[IL-6]]
* Chronic infection; excess release of [[IL-1]] and [[IL-6]]
|
| align="left" style="background:#F5F5F5;" |
* [[Normocytic anemia|Normocytic]] (80-100 femtoliter)
* [[Pallor]]
|
* [[Weakness]]
| align="left" style="background:#F5F5F5;" |  
* [[Normocytic anemia|Normocytic]]
| align="left" style="background:#F5F5F5;" |  
* Elevated [[ESR]] and [[CRP]]  
* Elevated [[ESR]] and [[CRP]]  
* Elevated [[hepcidin]]  
* Elevated [[hepcidin]]  
Line 152: Line 88:
* Low [[transferrin]]
* Low [[transferrin]]
* Elevated [[ferritin]]
* Elevated [[ferritin]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Pallor]]
 
* [[Weakness]]
|
* Treatment of the underlying cause; [[erythropoiesis]]-stimulating agents
* Treatment of the underlying cause; [[erythropoiesis]]-stimulating agents
* Supportive [[Red blood cell transfusion|red blood cell transfusions]]
* Supportive [[Red blood cell transfusion|red blood cell transfusions]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Inflammatory bowel disease]]
* [[Inflammatory bowel disease]]
|-
|-
|[[Thalassemia]]  
! align="center" style="background:#DCDCDC;" |[[Thalassemia]]<ref name="pmid25500521">{{cite journal |vauthors=Zainal NZ, Alauddin H, Ahmad S, Hussin NH |title=α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis |journal=Malays J Pathol |volume=36 |issue=3 |pages=207–11 |date=December 2014 |pmid=25500521 |doi= |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Genetic defect]] with alpha- or [[beta-globin]] production
* [[Genetic defect]] with alpha- or [[beta-globin]] production
|
| align="left" style="background:#F5F5F5;" |  
* [[Microcytic]] (<80 femtoliter)
|
* Abnormal [[hemoglobin]] [[electrophoresis]] (in [[beta-thalassemia]])
|
* [[Irritability]]  
* [[Irritability]]  
* [[Growth retardation]]  
* [[Growth retardation]]  
Line 175: Line 103:
* [[Hepatomegaly]]
* [[Hepatomegaly]]
* [[Splenomegaly]]
* [[Splenomegaly]]
|
| align="left" style="background:#F5F5F5;" |
* [[Microcytic]]
| align="left" style="background:#F5F5F5;" |
* Abnormal [[hemoglobin]] [[electrophoresis]] (in [[beta-thalassemia]])
| align="left" style="background:#F5F5F5;" |  
* [[Blood transfusion|Transfusion]] support
* [[Blood transfusion|Transfusion]] support
* [[Iron]] chelation
* [[Iron]] chelation
* [[Gene therapy]] if available
* [[Gene therapy]] if available
|
| align="left" style="background:#F5F5F5;" |  
* [[Extramedullary hematopoiesis]]
* [[Extramedullary hematopoiesis]]
|-
|-
|[[Iron deficiency anemia]]  
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]]<ref name="pmid25946282">{{cite journal |vauthors=Camaschella C |title=Iron-deficiency anemia |journal=N. Engl. J. Med. |volume=372 |issue=19 |pages=1832–43 |date=May 2015 |pmid=25946282 |doi=10.1056/NEJMra1401038 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* Loss of [[iron]] from [[gastrointestinal]] blood loss or [[menstrual]] [[blood loss]]
* Loss of [[iron]] from [[gastrointestinal]] blood loss or [[menstrual]] [[blood loss]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Microcytic]] (<80 femtoliter)
* [[Pallor]]
|
* [[Weakness]]
* Positive [[occult blood]] testing (if [[Gastrointestinal bleeding|GI bleeding]])
| align="left" style="background:#F5F5F5;" |
* [[Microcytic]]
| align="left" style="background:#F5F5F5;" |  
* Low serum [[iron]]  
* Low serum [[iron]]  
* Elevated [[transferrin]]  
* Elevated [[transferrin]]  
* Low [[transferrin saturation]]  
* Low [[transferrin saturation]]  
* Low [[ferritin]]
* Low [[ferritin]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Pallor]]
 
* [[Weakness]]
 
* Positive [[occult blood]] testing (if [[Gastrointestinal bleeding|GI bleeding]])
|
* Intravenous or oral iron supplementation
* Intravenous or oral iron supplementation
|
| align="left" style="background:#F5F5F5;" |  
* [[Blood loss|Chronic blood loss]]
* [[Blood loss|Chronic blood loss]]
|-
|-
|[[Erythropoietin]] deficiency
! align="center" style="background:#DCDCDC;" |[[Erythropoietin]] deficiency<ref name="pmid23727690">{{cite journal |vauthors=Yamazaki S, Souma T, Hirano I, Pan X, Minegishi N, Suzuki N, Yamamoto M |title=A mouse model of adult-onset anaemia due to erythropoietin deficiency |journal=Nat Commun |volume=4 |issue= |pages=1950 |date=2013 |pmid=23727690 |doi=10.1038/ncomms2950 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Chronic kidney disease]] or other [[renal dysfunction]]
* [[Chronic kidney disease]] or other [[renal dysfunction]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Normocytic anemia|Normocytic]] (80-100 femtoliter)
|
* Low [[Erythropoietin|erythropoietin level]]
|
* [[Pallor]]
* [[Pallor]]
* [[Weakness]]
* [[Weakness]]
* Signs of [[chronic kidney disease]]
* Signs of [[chronic kidney disease]]
|
| align="left" style="background:#F5F5F5;" |
* [[Normocytic anemia|Normocytic]]
| align="left" style="background:#F5F5F5;" |
* Low [[Erythropoietin|erythropoietin level]]
| align="left" style="background:#F5F5F5;" |  
* [[Epoetin alfa]] 50-100 units/kg 3 times weekly  
* [[Epoetin alfa]] 50-100 units/kg 3 times weekly  
* Darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks<ref name="pmid28626220">{{cite journal| author=Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J et al.| title=A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. | journal=Leukemia | year= 2017 | volume= 31 | issue= 9 | pages= 1944-1950 | pmid=28626220 | doi=10.1038/leu.2017.192 | pmc=5596208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28626220  }} </ref>
* Darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks<ref name="pmid28626220">{{cite journal| author=Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J et al.| title=A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. | journal=Leukemia | year= 2017 | volume= 31 | issue= 9 | pages= 1944-1950 | pmid=28626220 | doi=10.1038/leu.2017.192 | pmc=5596208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28626220  }} </ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Dialysis]] dependence
* [[Dialysis]] dependence
* [[Myelodysplastic syndrome]]
* [[Myelodysplastic syndrome]]
|-
|-
|[[Vitamin B12 deficiency|Vitamin B12]] or [[folate deficiency]]
! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency|Vitamin B12]] or [[folate deficiency]]<ref name="pmid25189324">{{cite journal |vauthors=Hunt A, Harrington D, Robinson S |title=Vitamin B12 deficiency |journal=BMJ |volume=349 |issue= |pages=g5226 |date=September 2014 |pmid=25189324 |doi= |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" |  
* [[Pernicious anemia]]
* [[Pernicious anemia]]
* [[Diphyllobothrium latum infection]]
* [[Diphyllobothrium latum infection]]
* [[Nutritional deficiency]]  
* [[Nutritional deficiency]]  
* [[Crohn's disease|Crohn's disease of terminal ileum]]
* [[Crohn's disease|Crohn's disease of terminal ileum]]
|
| align="left" style="background:#F5F5F5;" |  
* [[Macrocytic anemia|Macrocytic]] (>100 femtoliter)
|
* Low vitamin B12 or folate level
* [[Megaloblastic anemia]] with  hypersegmented [[neutrophils]]
|
* [[Numbness]]  
* [[Numbness]]  
* [[Weakness]]
* [[Weakness]]
* [[Tingling]]
* [[Tingling]]
* [[Paresthesias]]
* [[Paresthesias]]
|
| align="left" style="background:#F5F5F5;" |
* [[Macrocytic anemia|Macrocytic]]
| align="left" style="background:#F5F5F5;" |
* Low vitamin B12 or folate level
* [[Megaloblastic anemia]] with  hypersegmented [[neutrophils]]
| align="left" style="background:#F5F5F5;" |  
* [[Vitamin B12]] 1000mcg daily
* [[Vitamin B12]] 1000mcg daily
* [[Folate]] 1mg daily
* [[Folate]] 1mg daily
|
| align="left" style="background:#F5F5F5;" |  
* [[Neuropathy]]
* [[Neuropathy]]
|}
|}


'''Table legend:''' [[HELLP]], hemolysis/elevated liver enzymes/low platelets; '''TTP''', [[thrombotic thrombocytopenia purpura]]; '''CLL''', [[chronic lymphocytic leukemia]]
'''Table legend:''' [[HELLP]], hemolysis/elevated liver enzymes/low platelets; '''TTP''', thrombotic thrombocytopenic purpura; '''CLL''', [[chronic lymphocytic leukemia]]


==References==
==References==

Latest revision as of 20:55, 26 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shyam Patel [2]

Overview

The differential diagnosis for hemolytic anemia is broad and includes a variety of conditions that affect red blood cells. Nutritional deficiencies and thalassemias are important components of the differentiation. Certain laboratory tests and physical exam features can help to distinguish these conditions. The treatment of these conditions are quite different, so it is important to distinguish hemolytic anemia from other causes of anemia or other conditions that present similarly.

Differentiating Hemolytic anemia from other Diseases

Characterisitc/Parameter Etiology Physical examination Mean corpuscular volume Laboratory abnormalities Treatment Other associated abnormalities
Hemolytic anemia[1]
Sideroblastic anemia[2]
Anemia of chronic disease[3]
Thalassemia[4]
Iron deficiency anemia[5]
  • Intravenous or oral iron supplementation
Erythropoietin deficiency[6]
  • Epoetin alfa 50-100 units/kg 3 times weekly
  • Darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks[7]
Vitamin B12 or folate deficiency[8]

Table legend: HELLP, hemolysis/elevated liver enzymes/low platelets; TTP, thrombotic thrombocytopenic purpura; CLL, chronic lymphocytic leukemia

References

  1. ↑ Hill QA (October 2015). "Autoimmune hemolytic anemia". Hematology. 20 (9): 553–4. doi:10.1179/1024533215Z.000000000401. PMID 26447931.
  2. ↑ Bottomley SS, Fleming MD (August 2014). "Sideroblastic anemia: diagnosis and management". Hematol. Oncol. Clin. North Am. 28 (4): 653–70, v. doi:10.1016/j.hoc.2014.04.008. PMID 25064706.
  3. ↑ Roy CN (2010). "Anemia of inflammation". Hematology Am Soc Hematol Educ Program. 2010: 276–80. doi:10.1182/asheducation-2010.1.276. PMID 21239806.
  4. ↑ Zainal NZ, Alauddin H, Ahmad S, Hussin NH (December 2014). "α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis". Malays J Pathol. 36 (3): 207–11. PMID 25500521.
  5. ↑ Camaschella C (May 2015). "Iron-deficiency anemia". N. Engl. J. Med. 372 (19): 1832–43. doi:10.1056/NEJMra1401038. PMID 25946282.
  6. ↑ Yamazaki S, Souma T, Hirano I, Pan X, Minegishi N, Suzuki N, Yamamoto M (2013). "A mouse model of adult-onset anaemia due to erythropoietin deficiency". Nat Commun. 4: 1950. doi:10.1038/ncomms2950. PMID 23727690.
  7. ↑ Platzbecker U, Symeonidis A, Oliva EN, Goede JS, Delforge M, Mayer J; et al. (2017). "A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes". Leukemia. 31 (9): 1944–1950. doi:10.1038/leu.2017.192. PMC 5596208. PMID 28626220.
  8. ↑ Hunt A, Harrington D, Robinson S (September 2014). "Vitamin B12 deficiency". BMJ. 349: g5226. PMID 25189324.

Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Hemolytic_anemia_differential_diagnosis&oldid=1554505"