2. Anemia & increased reticulocytes
Is either due to hemorrhage or
hemolysis (increased peripheral loss)
Hemolysis is the rapid breakdown of RBCs which manifests itself with
anemia. Hemolytic anemia is diagnosed by the presence of elevated
indirect bilirubin and
in addition to anemia with increased retics.
Once hemolysis is established, the cause is determined using the clinical
test and red cell morphology on blood smear.
The history determines whether the hemolytic anemia is congenital or
Acquired hemolytic anemias result from immune or non-immune causes which
can be easily determined by a direct (antiglobulin)
- Intravascular hemolysis is hemolysis of RBCs inside the vascular
Extravascular hemolysis is RBC destruction in the reticuloendothelial
system particularly the spleen.
Haptoglobin is a protein that removes free Hgb, hence it decreases
in cases of intravascular hemolysis but remains normal in cases of extravascular
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