Diagnostic evaluation-hemolytic anemias

• ↑ retic count (RI >2%),

• ↑ LDH,

• ↓ hapto (83% Se, 96% Sp),

• ↑ indirect bili,

• ✓ vit C & Cu

• Autoimmune hemolysis

Location of hemolysis

(many conditions can include components of both)

Intravascular

RBC destruction in vessels (shear by mech valve, DIC, toxins); assoc. w/ hemoglobinemia, hemoglobinuria, hemosiderinuria,

• ↑↑ LDH, ↓ haptoglobin.

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Extravascular:

more common cause. Mϕ clear damaged/opsonized RBC; splenomegaly (reticuloendothelial expansion in spleen, liver, BM, LNs);

• ↑ LDH ↓ hapto
• Family h/o anemia; personal or family h/o cholelithiasis