Hemolytic anemia is caused by the premature breakdown of red blood cells, leading to decreased hemoglobin and red blood cell counts. There are inherited and acquired causes. The approach involves taking a medical history, physical exam, hematological and biochemical investigations like complete blood count and peripheral smear, and treating any underlying cause or complications. The hallmark diagnostic test is a positive direct antiglobulin test. Management may include glucocorticoids, splenectomy, or rituximab depending on the specific cause.

1. APPROACH TO
HAEMOLYTIC ANAEMIA
DR.DUR-E-ZAHRA

2. OUTLINE
 DEFINITION
 TYPES
 CAUSES
 APPROACH
i. HISTORY
ii. CLINICAL EXAMINATION
iii. INVESTIGATIONS
iv. MANAGEMENT

3. WHAT IS HAEMOLYTIC ANAEMIA?
BLOOD BREAKDOWN DECREASED RBC / HB
 HAEMOLYTIC ANEMIA is the anemia caused by the shortening of RBCs life span
due to lysis (breakdown) either intravascularly or extravascularly.

4. TYPES

5. CAUSES
Hemolytic
anemia
Inherited
Membrane
Defect
Enzyme
Deficiency
Haemoglobin
Defect
Acquired
Immune Infection Drugs/Toxins

6. APPROACH
A. HISTORY
B. PHYSICAL EXAM
C. INVESTIGATIONS
D. MANAGEMENT

7. HISTORY
 Acute or Chronic
 Medication or Drug Precipitant
G6PD
AIHA
 Family History
 Concomitant Medical Illnesses

8. CLINICAL EXAM
 Pallor
 Jaundice
 Splenomegaly
 Gall stones
 Dark Colored Urine`
 Leg Ulcers - chronic-- Sickle Cell Disease

9. HAEMATOLOGICAL INVESTIGATIONS
 CBC
low Hb
reticulocytosis
 Peripheral Smear

10. Peripheral Smear
 DETERMINES ETIOLOGY
 fragmented red cells(schistocytes)
denote Intravascular hemolysis
 while spherocytes denote
Extravascular hemolysis
Smear showing SCHISTOCYTES

11. BIOCHEMICAL INVESTIGATIONS
 Increased Unconjugated Haemoglobin
 Increased LDH
 Increased Urinary Urobilinogen
 Increased Methaemalbumin
 Low to absent Haptoglobin
 Positive urinary haemosiderin
 Haemoglobulinuria

12. HALLMARK OF DIAGNOSIS OF
HAEMOLYTIC ANAEMIA
Positive DAT (Direct Antiglobulin Test)
Also Called Direct Coomb’s Test

15. TREATMENT
 Correction of Complications of Haemolysis
 Identification and treatment of underlying cause
 Glucocorticoid (Prednisone 1mg/kg/day) is effective in 70-80% cases
 Second line treatments include
1. Splenectomy
2. Rituximab (a monoclonal antibody against CD 20 present on B-Cells)

16. REFERENCES
 Gurpreet Dhaliwal: Haemolytic Anemia ,American family physician,2004(69,11)
 http://www.med.umich.edu/digitallab
 Approach to haemolytic anemia by Abdulla Ansari @slide share
https://www.slideshare.net/AbdullahAnsaari?utm_campaign=profiletracking&utm_
medium=sssite&utm_source=ssslideview
 Hoffbrand’s Essentials of Haematology