Hemolysis - Differential Diagnosis Framework



1) Environment

  - Fragmentation

  - MAHA: TTP, HUS, DIC, HELLP

  - Grafts, Valves, AS

  - HTN/Pre-eclampsia



2) External (RBC Membrane):

  - Autoimmune: Warm AIHA, Cold AIHA, Transfusion reactions, Drug-associated, PCH, Evans Syndrome

  - Non-immune: Membrane Defects, Drugs, Liver Disease, PNH



3) Internal (RBC)

  - Infections/toxins: Malaria, Babesiosis, Bartonella, Clostridium, Snakes, Spiders

  - Enzyme Defects: G6PD, Pyruvate kinase

  - Hemoglobin Defects: Sickle cell anemia, Thalassemias, Unstable Hgb

  - Electrolytes: Wilson's disease, Hypophostphatemia



Laboratory Tests:

  - Haptoglobin ↓ 

  - Lactate Dehydrogenase ↑

  - Peripheral Blood Smear ↑ abnormal RBCs

  - Reticulocyte Count ↑

  - Unconjugated Bilirubin ↑

  - AST ↑

  - Urinalysis ↑ Urobilinogen



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