- Diagnosis
- History
- Examination
- Investigations
- History
- Management
- Interventions
The Haemolytic Screen
Haemolysis is the destruction of red blood cells prior to the end of their normal 120-day lifespan, and should be considered in anaemic patients with risk factors or no obvious cause of anaemia. Serum markers may be used to diagnose haemolysis and suggest a cause.
Markers of Haemolysis
Haemoglobin
A marker of severity
M: 130 - 180
F: 115 - 165Bilirubin
Unconjugated hyperbilirubinaemia caused by haem metabolism
<1 mg/dL
<20 µmol/LHaptoglobin
Reduced haptoglobin due to binding of free haemoglobin
36 - 195 mg/dLLactate Dehydrogenase
Elevated isoenzymes LDH1 and LDH2 in haemolysis
120 - 280 U/LReticulocytes
Evidence of compensatory erythopoiesis
50-100x10⁹/L
0.5 - 2.5%Markers of Intravascular Haemolysis
Plasma free haemoglobin, urine haemoglobin, urine haemosiderin
Diagnosing Cause
Read More...
Bain BJ. Diagnosis from the blood smear. New England Journal of Medicine. 2005 Aug 4;353(5):498-507.Barcellini W, Fattizzo B. Clinical applications of hemolytic markers in the differential diagnosis and management of hemolytic anemia. Disease markers. 2015 Dec 27;2015.Choi JW, Pai SH. Change in erythropoiesis with gestational age during pregnancy. Annals of hematology. 2001 Feb 16;80(1):26-31.Drent M, Cobben NA, Henderson RF, Wouters EF, van Dieijen-Visser M. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. European Respiratory Journal. 1996 Aug 1;9(8):1736-42.Gorst DW, Rawlinson VI, Merry AH, Stratton F. Positive direct antiglobulin test in normal individuals. Vox sanguinis. 1980 Feb 1;38(2):99-105.Lurie S, Mamet Y. Red blood cell survival and kinetics during pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000 Dec 31;93(2):185-92.Maekawa M. Lactate dehydrogenase isoenzymes. Journal of Chromatography B: Biomedical Sciences and Applications. 1988 Jul 29;429:373-98.Marchand A, Galen RS, Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. Jama. 1980 May 16;243(19):1909-11.Papadopoulos NM. Clinical applications of lactate dehydrogenase isoenzymes. Annals of Clinical & Laboratory Science. 1977 Nov 1;7(6):506-10.Parker V, Tormey CA. The Direct Antiglobulin Test: Indications, Interpretation, and Pitfalls. Archives of Pathology & Laboratory Medicine. 2017 Feb;141(2):305-10.Shih AW, McFarlane A, Verhovsek M. Haptoglobin testing in hemolysis: measurement and interpretation. American journal of hematology. 2014 Apr 1;89(4):443-7.Tabbara IA. Hemolytic anemias: diagnosis and management. Medical Clinics of North America. 1992 May 1;76(3):649-68.Ucar K. Clinical presentation and management of hemolytic anemias. Oncology. 2002 Sep 16;16(9; SUPP/10):163-70.Zantek ND, Koepsell SA, Tharp DR, Cohn CS. The direct antiglobulin test: a critical step in the evaluation of hemolysis. American journal of hematology. 2012 Jul 1;87(7):707-9.