Approach to Hemolytic Anemia

Abstract

Hemolysis is a common cause of anemia in hospitalized patients. The broad differential and potential for critical outcomes can make it an intimidating condition to evaluate. Fortunately, the more common and urgent etiologies can be promptly established through a systematic approach. This teaching script begins with a quick review of how to distinguish the three causes of anemia-underproduction, blood loss, and hemolysis-based on the reticulocyte index and a few easily obtained laboratory tests. It then progresses through a step-wise approach to differentiating the eight common causes of hemolysis, based simply on the peripheral blood smear, direct antibody test and one unique characteristic of the clinical presentation.