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2. Anemia & increased reticulocytes

Is either due to hemorrhage or hemolysis (increased peripheral loss)

1. Blood loss


2. Hemolytic anemia

Elevated indirect bilirubin and LDH

Hemolysis is the rapid breakdown of RBCs which manifests itself with jaundice and anemia. Hemolytic anemia is diagnosed by the presence of elevated indirect bilirubin and LDH in addition to anemia with increased retics.

Once hemolysis is established, the cause is determined using the clinical history, Coombs' test and red cell morphology on blood smear.

The history determines whether the hemolytic anemia is congenital or acquired.

Acquired hemolytic anemias result from immune or non-immune causes which can be easily determined by a direct (antiglobulin) Coomb test.

  • Intravascular hemolysis is hemolysis of RBCs inside the vascular system and
    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 hemolysis.
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