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hemolytic-anemia-algorithm.pdf

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SAURABH SINGH

HEMOLYTIC ANEMIA

Healthcare
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Hemolytic Anemia Diagnostic Algorithm Erythrocyte Diagnostic Laboratory l Phone: (513) 636-4234 l Fax: (513) 636-2106 Email: CBDILabs@cchmc.org l www.cchmc.org/EDL
Consider PNH Consider physical agents including MAHA/HUS/aHUS/TTP Work-up for autoimmune or alloimmune causes Positive suboptimal reticulocytosis, iron overload, or skeletal abnormalities Negative DAT and indirect Coombs Anemia with reticulocytosis (jaundice, splenomegaly, é LDH, ê haptoglobin) Family History and Blood Smear Review to assist with diagnosis normal except erythroid hyperplasia binuclear or multinuclear erythroblasts CDA gene panel RBC enzymopathies gene panel Normal Globin gene sequencing and deletion/duplication analysis Abnormal Abnormal RBC membrane disorders gene panel, especially if splenectomy is contemplated RBC enzyme activity Globin gene and HHA/CDA panel or subpanels depending on family history and smear review Bone Marrow Studies Hemolytic Anemia Diagnostic Algorithm No Chronically transfused patient Normal Normal Ektacytometry (osmotic fragility also an option, although less sensitive) Ektacytometry indicating RBC membrane disorder Hemoglobin Electrophoresis Abnormal Yes BRV216575

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hemolytic-anemia-algorithm.pdf

  • 1. Hemolytic Anemia Diagnostic Algorithm Erythrocyte Diagnostic Laboratory l Phone: (513) 636-4234 l Fax: (513) 636-2106 Email: CBDILabs@cchmc.org l www.cchmc.org/EDL
  • 2. Consider PNH Consider physical agents including MAHA/HUS/aHUS/TTP Work-up for autoimmune or alloimmune causes Positive suboptimal reticulocytosis, iron overload, or skeletal abnormalities Negative DAT and indirect Coombs Anemia with reticulocytosis (jaundice, splenomegaly, é LDH, ê haptoglobin) Family History and Blood Smear Review to assist with diagnosis normal except erythroid hyperplasia binuclear or multinuclear erythroblasts CDA gene panel RBC enzymopathies gene panel Normal Globin gene sequencing and deletion/duplication analysis Abnormal Abnormal RBC membrane disorders gene panel, especially if splenectomy is contemplated RBC enzyme activity Globin gene and HHA/CDA panel or subpanels depending on family history and smear review Bone Marrow Studies Hemolytic Anemia Diagnostic Algorithm No Chronically transfused patient Normal Normal Ektacytometry (osmotic fragility also an option, although less sensitive) Ektacytometry indicating RBC membrane disorder Hemoglobin Electrophoresis Abnormal Yes BRV216575