Finding | Change in hemolytic anemia |
Anemia* | Decreased hemoglobin Decreased hematocrit |
Bone marrow response/recovery | Increased reticulocyte count Underestimation of HbA1C |
Release of RBC contents | Increased LDH Increased indirect bilirubin Decreased haptoglobin Hemoglobinemia in intravascular hemolysis¶ Hemoglobinuria in intravascular hemolysis¶ |
RBC morphology changesΔ | Spherocytes or microspherocytes in immune hemolysis Schistocytes in microangiopathic hemolysis Blister or bite cells in oxidant injury Sickle cells in sickle cell disease Target cells and teardrop cells in thalassemia |
HbA1C: glycosylated (glycated) hemoglobin; RBC: red blood cell; LDH: lactate dehydrogenase; DIC: disseminated intravascular coagulation; AKI: acute kidney injury.
* The presence and severity of anemia depends on the degree of hemolysis and capacity of the bone marrow to compensate by increasing erythropoiesis.
¶ Intravascular hemolysis can be a medical emergency with free hemoglobin in the blood and associated with complications including DIC and acute renal failure. Findings associated with intravascular hemolysis may include schistocytes on the blood smear, hemoglobinemia (with red serum), hemoglobinuria (with dark or red urine), and hemosiderinuria in the urine sediment.
Δ Refer to UpToDate for additional details of these and other RBC morphologies and their implications.Do you want to add Medilib to your home screen?