Hemolytic anemia differential diagnosis: Difference between revisions
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! scope="col" | '''Iron-deficiency anemia''' | ! scope="col" | '''Iron-deficiency anemia''' | ||
! scope="col" | '''Erythropoietin deficiency''' | ! scope="col" | '''Erythropoietin deficiency''' | ||
! scope="col" | '''Vitamin B12 | ! scope="col" | '''Vitamin B12 or folate deficiency''' | ||
|- | |- | ||
! scope="row" | Etiology | ! scope="row" | Etiology | ||
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| Alcoholism, lead poisoning, vitamin B6 deficiency, isoniazid, chloramphenicol | | 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 | | 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 | ||
| [[Petechiae]], [[bleeding]], other [[autoimmune diseases]] | | [[Petechiae]], [[bleeding]], other [[autoimmune diseases]] | ||
| [[Petechia]]<nowiki/>e, [[purpura]], [[ecchymoses]] | | [[Petechia]]<nowiki/>e, [[purpura]], [[ecchymoses]] | ||
| [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]] | | [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]] | ||
|- | |- | ||
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| Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | ||
| Normocytic (80-100 femtoliter) | | Normocytic (80-100 femtoliter) | ||
| | | Microcytic (<80 femtoliter) | ||
| Low; can be as low as 10000 per microliter | | Low; can be as low as 10000 per microliter | ||
| Low; can be less than 10000 per microliter; sudden onset after [[transfusion]] | | Low; can be less than 10000 per microliter; sudden onset after [[transfusion]] | ||
| Variable; usually low | | Variable; usually low | ||
|- | |- | ||
! scope="row" | Laboratory abnormalities | ! scope="row" | Laboratory abnormalities | ||
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| Ringed sideroblasts in bone marrow; low vitamin B6 level, high lead level | | 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 | | Elevated ESR and CRP, elevated hepcidin, low serum iron, low transferrin, elevated ferritin | ||
| | | Abnormal hemoglobin electrophoresis (in beta-thalassemia) | ||
| Normal | | Normal | ||
| Normal | | Normal | ||
| Usually normal | | Usually normal | ||
|- | |- | ||
! scope="row" | Physical exam | ! scope="row" | Physical exam | ||
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| Pallor, weakness | | Pallor, weakness | ||
| Pallor, weakness | | Pallor, weakness | ||
| | | Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | ||
| Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]] | | Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]] | ||
| Exposure to transfused products | | Exposure to transfused products | ||
| Autoimmunity with development of [[antibodies]] to [[DNA]] | | Autoimmunity with development of [[antibodies]] to [[DNA]] | ||
|- | |- | ||
! scope="row" | Treatment | ! scope="row" | Treatment | ||
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| Removal of offending medication, high-dose vitamin B6 (up to 200mg daily), avoidance of splenectomy, symptomatic transfusion support with iron chelation as needed | | 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 | | Treatment of the underlying cause; erythropoiesis-stimulating agents, supportive red blood cell transfusions | ||
| | | Transfusion support, iron chelation, gene therapy if available | ||
| Yes | | Yes | ||
| No; transfusion-related | | No; transfusion-related | ||
| Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]] | | Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]] | ||
|- | |- | ||
! scope="row" | Other associated abnormalities | ! scope="row" | Other associated abnormalities | ||
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| Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | ||
| Inflammatory bowel disease | | Inflammatory bowel disease | ||
| | | Extramedullary hematopoiesis | ||
| Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter | | Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter | ||
| Yes; spontaneous bleeding if platelet count < 10000 per microliter | | Yes; spontaneous bleeding if platelet count < 10000 per microliter | ||
| Rare | | Rare | ||
|} | |} | ||
Revision as of 05:12, 5 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
Differentiating Hemolytic anemia from other Diseases
| Characteristic/Parameter | Hemolytic anemia | Sideroblastic anemia | Anemia of chronic disease | Thalassemia | Iron-deficiency anemia | Erythropoietin deficiency | Vitamin B12 or folate deficiency |
|---|---|---|---|---|---|---|---|
| Etiology | Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease | 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 | Petechiae, bleeding, other autoimmune diseases | Petechiae, purpura, ecchymoses | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
| Mean corpuscular volume | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) or normocytic (80-100 femtoliter) | Normocytic (80-100 femtoliter) | Microcytic (<80 femtoliter) | Low; can be as low as 10000 per microliter | Low; can be less than 10000 per microliter; sudden onset after transfusion | Variable; usually low |
| 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) | Normal | Normal | Usually normal |
| Physical exam | Pallor, jaundice | Pallor, weakness | Pallor, weakness | Irritability, growth retardation, jaundice, hepatomegaly, splenomegaly | Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori | Exposure to transfused products | Autoimmunity with development of antibodies to DNA |
| 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 | Yes | No; transfusion-related | Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid |
| Other associated abnormalities | HELLP syndrome, TTP, CLL | Myelodysplastic syndrome, myeloproliferative neoplasm, iron overload | Inflammatory bowel disease | Extramedullary hematopoiesis | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Rare |