Medicine residents what to do with hemolytic anemia😵💫
A simple approach to make your life easy peasy.
No. 1 - establish hemolysis
No. 2 - determine the type and cause
No. 3- treat it
Lets discuss 1 by 1.
A simple approach to make your life easy peasy.
No. 1 - establish hemolysis
No. 2 - determine the type and cause
No. 3- treat it
Lets discuss 1 by 1.
Establish hemolysis - Low hemoglobin, high mcv( not always), high retic count ( compensatory increase in immature RBCs, low haptoglobin, raise in indirect bilirubin and high LDH.
Type and cause - Run a coombs test > positive (3+ or 4+) > check monospecific coombs to check whether IgG is + ( warm type, steroids work) or C3d is + cold type, no role of steroids).
If coombs negative > think of structural disorders/enzyme disorders or hemoglobin disorders
If coombs negative > think of structural disorders/enzyme disorders or hemoglobin disorders
Peripheral blood morphology will guide you about a lot of lot of things like?
Beta Thallesemia major (syndrome)
Spherocytosis, eliptocyte
Red blood cell agglutination etc.
Actually many rare things
Beta Thallesemia major (syndrome)
Spherocytosis, eliptocyte
Red blood cell agglutination etc.
Actually many rare things
History of recurrent jaundice since birth along with siblings, with splenomegaly on examination, can be suggestive of hereditary membrane defect like spherocytosis. If high suspicion send osmotic fragility test. Ema binding test if available.
If suspicion of hemogobinopathy, send hemoglobin electrophoresis(HPLC). Or specific gene sequencing for thallesemia if high suspicion with peripheral morphology.
If you still have heat instability test, get that done if still nothing works out, some hemoglobin become unstable .
If you still have heat instability test, get that done if still nothing works out, some hemoglobin become unstable .
At a particular temperature and break.
Another cause is G6PD deficiency. Patient will give you a history of ingesting some new food or medicine after which he develops severe jaundice.
There is a long list of causes of hemolysis but just keep these broad causes on your diff.
Another cause is G6PD deficiency. Patient will give you a history of ingesting some new food or medicine after which he develops severe jaundice.
There is a long list of causes of hemolysis but just keep these broad causes on your diff.
Warm autoimmune HA - Rx. Steroids 1mg/kg for 2-4 weeks and then taper very slowly unlike ITP. Stopping quickly will result in relapse of anemia.
Always rule out underlying cause, could be lymphoma, other malignancy, etc.
Always rule out underlying cause, could be lymphoma, other malignancy, etc.
Cold auto HA - Rx Rituximab for symptomatic anemia.
Could be cold agglutinin disease, paroxymal cold hemoglobinuria etc.
Just know the names and refer to a hematologist.
G6PD - Avoid foods and medicines known to cause hemolysis.
Hereditary spherocytosis - splenectomy ..
Could be cold agglutinin disease, paroxymal cold hemoglobinuria etc.
Just know the names and refer to a hematologist.
G6PD - Avoid foods and medicines known to cause hemolysis.
Hereditary spherocytosis - splenectomy ..
Is an option.
Last thing but the most important one.
All patients who have chronic hemolysis will consume folic acid and will become deficient. Keep them on low dose folate replacement. Tab Folic acid 5 mg od life long.
This is the easiest approach i could give you guys.
Last thing but the most important one.
All patients who have chronic hemolysis will consume folic acid and will become deficient. Keep them on low dose folate replacement. Tab Folic acid 5 mg od life long.
This is the easiest approach i could give you guys.
To make it difficult there are 1000 ways. And thats not my approach.
Bye🫠
Bye🫠
Loading suggestions...