Haemolysis: Causes, Diagnosis and Management | Medical Learner

Haemolysis

Shortening of erythrocyte lifespan below the expected 120 days. Marked intravascular haemolysis may lead to jaundice and haemoglobinuria.

Contents Causes Diagnosis Management

Causes

• Blood transfusion reactions.
• Malaria.
• Sickle cell haemolytic crisis.
• Drugs, e.g. high-dose penicillin, methyl dopa.
• Autoimmune (cold or warm antibody-mediated)—may be idiopathic or secondary, e.g. lymphoma, SLE, mycoplasma.
• Haemolytic uraemic syndrome/thrombotic thrombocytopaenic purpura (microangiopathic haemolytic anaemia).
• Trauma (cardiac valve prosthesis).
• Glucose-6-phosphate dehydrogenase deficiency—oxidative crises occur following ingestion of fava beans or administration of drugs (e.g. primaquine, sulphonamides) leading to rapid onset anaemia and jaundice.

Diagnosis

• Unconjugated hyperbilirubinaemia, increased urinary urobilinogen (increased RBC breakdown).
• Reticulocytosis (increased RBC production).
• Splenic hypertrophy (extravascular haemolysis).
• Methaemoglobinaemia, haemoglobinuria, free plasma haemoglobin (intravascular haemolysis), reduced serum haptoglobins.
• RBC fragmentation (microangiopathic haemolytic anaemia).
• Coombs’ test (immune-mediated haemolysis).
• Other (including haemoglobin electrophoresis, bone marrow biopsy).

Management

• Identification and specific treatment of the cause where possible.
• Blood transfusion to maintain haemoglobin >7g/dL.
• Massive intravascular haemolysis may lead to acute renal failure. Maintain a good diuresis and haemo(dia)filter if necessary.

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