Hemolytic anemia differential diagnosis: Difference between revisions

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| Loss of iron from gastrointestinal blood loss or menstrual blood loss
| Loss of iron from gastrointestinal blood loss or menstrual blood loss
| Chronic kidney disease or other renal dysfunction
| Chronic kidney disease or other renal dysfunction
| [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]]
| Pernicious anemia, Diphyllobothrium latum infection, nutritional deficiency, Crohn's disease of terminal ileum
|-
|-
! scope="row" | Mean corpuscular volume
! scope="row" | Mean corpuscular volume
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| Microcytic (<80 femtoliter)
| Microcytic (<80 femtoliter)
| Normocytic (80-100 femtoliter)
| Normocytic (80-100 femtoliter)
| Variable; usually low
| Macrocytic (>100 femtoliter)
|-
|-
! scope="row" | Laboratory abnormalities
! scope="row" | Laboratory abnormalities
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| Low serum iron, elevated transferrin, low transferrin saturation, low ferritin
| Low serum iron, elevated transferrin, low transferrin saturation, low ferritin
| Low erythropoietin level
| Low erythropoietin level
| Usually normal
| Low vitamin B12 or folate level, megaloblastic anemia and hypersegmented neutrophils
|-
|-
! scope="row" | Physical exam
! scope="row" | Physical exam
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| Pallor, weakness, positive occult blood testing (if GI bleeding)
| Pallor, weakness, positive occult blood testing (if GI bleeding)
| Pallor, weakness, signs of chronic kidney disease
| Pallor, weakness, signs of chronic kidney disease
| Autoimmunity with development of [[antibodies]] to [[DNA]]
| Numbness, weakness, tingling, paresthesias
|-
|-
! scope="row" | Treatment
! scope="row" | Treatment
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| Intravenous or oral iron supplementation
| 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
| Epoetin alfa 50-100 units/kg 3 times weekly, darbepoietin 0.45 mcg/kg weekly or 0.75 mcg/kg every 2 weeks
| Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]]
| Vitamin B12 1000mcg daily, folate 1mg daily
|-
|-
! scope="row" | Other associated abnormalities
! scope="row" | Other associated abnormalities
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| Chronic blood loss
| Chronic blood loss
| Dialysis dependence, myelodysplastic syndrome
| Dialysis dependence, myelodysplastic syndrome
| Rare
| Neuropathy
|}
|}



Revision as of 06:14, 5 October 2017

Hemolytic anemia Microchapters

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Causes

Differentiating Hemolytic anemia from other Diseases

Epidemiology and Demographics

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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 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
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)
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
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
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
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

References

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