Acquired hemolytic anemia

Acquired hemolytic anemia
Classification and external resources
Specialty	hematology
ICD-10	D59
ICD-9-CM	283

Acquired hemolytic anemia can be divided into immune and non-immune mediated forms of hemolytic anemia.

Immune

Immune mediated hemolytic anaemia (direct Coombs test is positive)

Autoimmune hemolytic anemia
- Warm antibody autoimmune hemolytic anemia
  - Idiopathic
  - Systemic lupus erythematosus (SLE)
  - Evans' syndrome (antiplatelet antibodies and hemolytic antibodies)
- Cold antibody autoimmune hemolytic anemia
  - Idiopathic cold hemagglutinin syndrome
  - Infectious mononucleosis and mycoplasma (atypical) pneumonia
  - Paroxysmal cold hemoglobinuria (rare)
Alloimmune hemolytic anemia
- Hemolytic disease of the newborn (HDN)
  - Rh disease (Rh D)
  - ABO hemolytic disease of the newborn
  - Anti-Kell hemolytic disease of the newborn
  - Rhesus c hemolytic disease of the newborn
  - Rhesus E hemolytic disease of the newborn
  - Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, MN, P and others)
- Alloimmune hemolytic blood transfusion reactions (i.e., from a non-compatible blood type)
Drug induced immune mediated hemolytic anemia
- Penicillin (high dose)
- Methyldopa

Non-immune

Non-immune mediated hemolytic anemia (direct Coombs test is negative)

Drugs (i.e., some drugs and other ingested substances lead to hemolysis by direct action on RBCs, e.g., ribavirin )
Toxins (e.g., snake venom; plant poisons such as aesculin)
Trauma
- Mechanical (from heart valves, extensive vascular surgery, microvascular disease, repeated mechanical vascular trauma)
Microangiopathic hemolytic anemia (a specific subtype with causes such as TTP, HUS, DIC and HELLP syndrome)
Infections (Note: Direct Coombs test is sometimes positive in hemolytic anemia due to infection)
Membrane disorders
- Paroxysmal nocturnal hemoglobinuria (rare acquired clonal disorder of red blood cell surface proteins)
- Liver disease

Drug induced hemolysis

Drug induced hemolysis has large clinical relevance. It occurs when drugs actively provoke red blood cell destruction. It can be divided in the following manner:

A total of four mechanisms are usually described, but there is some evidence that these mechanisms may overlap.^[1]

References

↑ Wright MS (1999). "Drug-induced hemolytic anemias: increasing complications to therapeutic interventions". Clin Lab Sci. 12 (2): 115–8. PMID 10387489.

Diseases of red blood cells (D50–69,74, 280–287)

↑

Polycythemia	Polycythemia vera

↓

Anemia

Nutritional

Micro-: Iron-deficiency anemia
- Plummer–Vinson syndrome

Macro-: Megaloblastic anemia
- Pernicious anemia

Hemolytic
(mostly normo-)

Hereditary	enzymopathy: G6PD glycolysis PK TI HK hemoglobinopathy: Thalassemia alpha beta delta Sickle-cell disease/trait HPFH membrane: Hereditary spherocytosis Minkowski–Chauffard syndrome Hereditary elliptocytosis Southeast Asian ovalocytosis Hereditary stomatocytosis

Acquired	Autoimmune WAHA CAD PCH membrane PNH MAHA TM HUS Drug-induced autoimmune Drug-induced nonautoimmune Hemolytic disease of the newborn

Aplastic
(mostly normo-)

Blood tests

MCV
MCHC
- Normochromic
- Hypochromic

Other

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