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Anemia with increased reticulocytes

i. Acquired hemolysis

History suggestive of acquired hemolysis

acquired hemolysis is either of immune cause or non-immune cause.

a. autoimmune hemolysis

Direct Coombs test positive

The direct Coombs' (antiglobulin) reaction is used to detect the presence of immunoglobulin or complement on the red-cell membrane and to determine the specific class of immunoglobulin or complement present.

1. Warm antibody hemolytic anemia (IgG):

 Direct Coombs test IgG / IgG & C3

Antibodies interact best with RBCs at 37? C. Hemolysis is primarily extravascular (serum haptoglobin normal).

  1. Drug induced:
    Clinical suspicion: Once the diagnosis of hemolytic anemia  is established drug intake must be excluded.
  2. Underlying hematological malignancy
  3. Collagen vascular disorders
  4. Infections
  5. Idiopathic

1. Cold antibody hemolytic anemia (IgM):

 Direct Coombs test  C3 only

Cold antibody hemolytic anemia:
Antibodies interact best with RBCs at 4? C. Hemolysis is mainly in the liver but maybe intravascular (serum haptoglobin decreased).

  1. Paroxysmal cold hemoglobinuria
  2. Cold agglutinin disease
  3. Mycoplasma and viral infections
  4. idiopathic
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b. non-immune hemolysis

Direct Coombs test  negative

  • Hypersplenism
  • Microangiopathic
  • Chemical agents
  • Physical agents
  • Lipid abnormalities
  • Infectious agents

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