APPROACH TO ANEMIA,lessson of blood,

1. APPROACH TO
ANEMIA
DR.ABDULLAH SEDAGHAT

2. What is CBC?
Complete Blood Count :
Hb, RBC, MCV, MCH, MCHC, WBC & Diff, Platelet,
Reticulocyte

3. Anemia
• RBC mass
• ed level of Hb more than 2SD of mean normal of Hb
according to age
Age Hb level
• New born <13 gr/dl
• 2-3 months < 9 FT
< 7 premature
• 6m-2y <9.5
• 2y – 6 years old <10.5
• 6 – 12 y/o <11.5
• >12 y/o Male < 14
Female < 12

4. MCV
• Mean corpuscular volume:  100 (fl)
• Age: 2-10 y/o MCV= Age (year) + 70
• Age ≥ 10 y/o MCV < 80: Microcytosis
MCH
• Mean corpuscular hemoglobin:  100 (Pg)
• More sensitive than MCV
• MCH 25- 27 hypochromia
Rbc
HCT

5. MCHC
• Mean corpuscular hemoglobin concentration:
 100   100
• It is important in diagnosis of congenital
Spherocytosis (MCHC > 35)
:
Rbc
Hb
Rbc
HCT

6. PCV or Hematocrit
•57% Plasma
•1% Buffy coat – WBC
•42% Hct (PCV)
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7. The Three Basic
Measures
Measurement Normal Range
A. RBC count 5 million 4 to 6
B. Hemoglobin 15 g% 12 to 17
C. Hematocrit 45 38 to 50
A x 3 = B x 3 = C - This is the rule of thumb
Check whether this holds good in given results
If not -indicates micro or macrocytosis or hypochro.
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8. Anaemia – First Test
RETICULOCYTE COUNT %
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Normal
Less than 2%
• ‘RBC to be’ or Apprentice RBC
• Fragments of nuclear material
• RNA strands which stain blue

11. The reticulocyte count
(kinetic approach)
• Increased reticulocytes (greater than 2-3% or
100,000/mm3 total) are seen in blood loss and
hemolytic processes, although up to 25% of
hemolytic anemias will present with a normal
reticulocyte count due to immune destruction of red
cell precursors.
• Retic counts are most helpful if extremely low
(<0.1%) or greater than 3% (100,000/mm3 total).

12. The reticulocyte count
• To be useful the reticulocyte count must be adjusted for
the patient's hematocrit. Also when the hematocrit is
lower reticulocytes are released earlier from the marrow
so one can adjust for this phenomenon. Thus:
• Corrected retic. = Patients retic. x (Patients Hct/45)
• Reticulocyte index (RPI) = corrected retic.
count/Maturation time
(Maturation time = 1 for Hct=45%, 1.5 for 35%, 2 for
25%, and 2.5 for 15%.)
• Absolute reticulocyte count = retic x RBC number.

14. Types of Anaemia
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15. Workup – Second Test
• The next step is ‘What is the size of RBC’ ?
• MCV indicates the Red cell volume (size)
• Both the MCH & MCHC tell Hb content of RBC
• If the RPI is 2 or less
• We are dealing with either
• Hypoproliferative anaemia (lack of raw material)
• Maturation defect with less production
• Bone marrow suppression (primary/ secondary)
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16. Red Cell Size
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17. Anaemia Workup - MCV
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Microcytic
MCV
Normocytic Macrocytic
Iron Deficiency IDA
Chronic Infections
Thalassemias
Hemoglobinopathies
Sideroblastic Anemia
Chronic disease
Early IDA
Hemoglobinopathies
Primary marrow
disorders
Combined deficiencies
Increased destruction
Megaloblastic
anemias
Liver disease/alcohol
Hemoglobinopathies
Metabolic disorders
Marrow disorders
Increased destruction

18. CLASSIFICATION
• Classification by Pathophysiology
• Blood Loss
• Decreased Production
• Increased Destruction
• Classification by Morphology
• Normocytic
• Microcytic
• Macrocytic

19. Anaemia Workup – 3rd Test
Red cell Distribution Width – RDW
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RDW < 13
Mean 90 fl
RDW is 13
MCV 90 fl

20. RDW
• Red cell distribution width = anisocytosis
• RDW = 11-14.5%
• IDA: RDW
• -thalassemia minor: NL or RDW

21. Anaemia Workup - 4th Test
Peripheral Smear Study
• Are all RBC of the same size ?
• Are all RBC of the same normal discoid shape ?
• How is the colour (Hb content) saturation ?
• Are all the RBC of same colour/ multi coloured ?
• Are there any RBC inclusions ?
• Are intra RBC there any hemo-parasites ?
• Are leucocytes normal in number and D.C ?
• Is platelet distribution adequate ?
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22. Basophilic Stippling -
MBAwww.drsarma.in
BS occurs in Lead poisoning also

23. RBC morphology
• 7-9 m with 1/3 central palor
• Lifespan of 110-120 days
• About the size of nucleus of normal lymphocyte
• Poikilocytosis & Anisocytosis

24. Basophilic stippling
• lead or heavy metal
poisoning
• Hemolytic anemia

25. Elliptocytes/ovalocytes
• Abnormal cytoskeletal
proteins
• Hereditary elliptocytosis

26. Howell Jolly body
• Nuclear remnant - DNA
• hemolytic anemia
• absent or hypofunction
spleen

27. HISTORY
AGE: Nutritional iron deficiency is never responsible for
anemia in term infants before 6 months of age; rarely seen in
premature infants before the time that they have doubled their
birth weight.
Anemia occurring in the neonatal period is generally the result
of recent blood loss, isoimmunization, or initial manifestation of
a congenital hemolytic anemia or congenital infection
Anemia first detected at 3 to 6 months of age suggests a
congenital disorder of hemoglobin synthesis or hemoglobin
structure
Gender: Consider X-linked disorders in males (G6PD
deficiency, pyruvate kinase deficiency)

28. History
Drug: Oxidant-induced hemolytic anemia, phenytoin (Dilantin)-
induced megaloblastic anemia, drug-induced aplastic anemia
Infectious: Hepatitis-induced aplastic anemia, infection-induced
red cell aplasia, hemolytic anemia
Inheritance: Family history of anemia, jaundice, gallstones, or
splenomegaly
Diarrehia: Suspect small bowel disease with malabsorption of
folate or vitamin BIz. Suspect inflammatory bowel disease with
blood loss. Suspect exudative enteropathy with blood loss

29. History
Neonatal: A history of hyperbilirubinemia in the
newborn period suggests the presence of congenital
hemolytic anemia, such as the hereditary spherocytosis
of G6PD deficiency. Prematurity predisposes to the
early development of iron deficiency
Diet:Document sources of iron, vitamin BIz, folic
acid, or vitamin E in the diet. A history of pica,
geophagia, or pagophagia suggests the presence of iron
deficiency

30. Basic chemistries
• BUN, creatinine,LFT
• Bilirubin, icterus = 2.5mg/dl (direct and indirect)
• LDH, haptoglobin / RETIC /Coombs
• Iron/TIBC
• Ferritin / Hb electropheresis /
• Folic acid
• Vitamin B12
• Osmotic fragility
• G6pd def / piruvate kinase def /

31. Macrocytic Anaemias
A. Megaloblastic Macrocytic – B12 and
Folate↓
B. Non Megaloblastic Macrocytic Anaemias
1. Liver disease/alcohol
2. Hemoglobinopathies
3. Metabolic disorders, Hypothyroidism
4. Myelodystrophy, BM infiltration
5. Accelerated Erythropoesis -↑destruction
6. Drugs (cytotoxics, immunosuppressants, AZT,
anticonvulsants)
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32. Macrocytic: RPI < 2
B12/Folate
B12 Low Normal
MMA High
MMA
Homocysteine
Normal
Consider
Liver, Renal,
Thyroid,
Alcohol,
Chronic dis.
Consider
Bone Marrow
Bx
Homocysteine
High
Folate Low

33. Macrocytic: RPI >= 2
Occult
Blood Loss?
Yes
Investigate
source
No
Coombs’
(DAT)
Check for
Hemolysis
Peripheral
smear

34. Macrocytic: RPI >= 2 Hemolytic Anemia
Coombs’ (DAT)
Positive
Immune Hemolysis
Drug related Hemolysis
Transfusion, Infection,
Cancer
Negative
Hemoglobinopathy, G6PD,
PK,
Spherocytosis,
Eliptocytosis,
PNH, TTP, DIC

35. Anaemia
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Hypoproliferative Hemolytic
RPI < 2 RPI > 2

36. Blood Loss
• Acute
• Traumatic
• Variety of sources
• Melena, hematemesis, menometrorrhagia
• Chronic
• Occult bleeding
• Colonic polyp/carcinonma

37. INCREASED DESTRUCTION
•Immune Mediated
•Non-immune Mediated

38. Increased Destruction
IMMUNE MEDIATED
• Cold Agglutinin
• Paroxysmal nocturnal hemoglobinuria
• Post mycoplasmal hemolytic anemia
• Warm Agglutinin
• Drug induced
• Autoimmune hemolytic anemia
• Transfusion reaction

39. Increased Destruction
NON-IMMUNE MEDIATED
• Extra-corpuscular
• Macro-circulatory
• Hypersplenism
• Extracorporeal circulation
• Micro-circulatory
• DIC
• TTP
• HUS
• Intra-corpuscular
• RBC Wall (membrane or enzyme defects)
• Heme or globin abnormalities (HbS, C)

40. Hypoproliferative
Anaemias
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Failure of cell
maturation
Nuclear
breakdown
Cytoplasmic
breakdown
Megaloblastic Anaemia
Defective DNA synthesis
Folate or B12 deficiency Haem defect Globin defect
Thalassemia
Sickle cell AFe Phorph
IDA, SA

41. Decreased Production
• Infectious
• Neoplastic
• Endocrine
• Nutritional Deficiency
• Anemia of Chronic Disease

42. Decreased Production
INFECTIOUS
Bacterial
• Tuberculosis
• Viral
• HIV / Parvovirus
ENDOCRINE
• Thyroid Dysfunction
• Hypothyroidism
• Erythropoietin Deficiency
• Renal Failure

43. Decreased Production
NEOPLASTIC
• Leukemia
• Lymphoma/Myeloma
• Myeloproliferative Syndromes
• Myelodysplasia
NUTRITIONAL DEFICIENCY
• Iron
• B12
• Folate

44. Normocytic Anaemias
1. Chronic disease
2. Early IDA
3. Hemoglobinopathies
4. Primary marrow disorders
5. Combined deficiencies
6. Increased destruction
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45. Normocytic – Normochromic
Anemia
Reticulocyte count
< 1% ≥ 2.5%
Wbc & Plt count Hemorrhage Hemolysis
Coombs test
Low
Pancytopenia
BMA & bx
Aplastic anemia
leukemia
NL
Pure red cell anemia
BMA
Congenital (DBA)
VS acquired (TEC)
- ve
- Membrane defect
- Hb pathy
- Enzyme deficiency
- Unstable Hb
- HUS
- Wilson disease
- DIC
+ ve
Autoimmune
hemolytic anemia

46. Macrocytic: RPI < 2
Megaloblastic Anemia
B12
• Inadequate absorption
• Synthesized by bacteria
• Meat, fish, dairy (strict
vegans)
• Absorbed as B12-IF
complex in ileum
(gastrectomy)
• Ca++ and pH dependant
(PPI)
Folate
• Inadequate intake
• Synthesized by plants and
micro-organism
• Green leafy vege’s
• Fruits
• Absorbed in jejunum

47. Macrocytic: RPI >= 2
Hemolytic Anemia
Other Lab Characteristics
• RBC morphology
• Serum haptoglobin
• Serum LDH
• Unconjugated bilirubin
• Hemoglobinuria
• Hemosiderinuria

48. Microcytic hypochromic
anemia
1. IDA
2.  or  thalassemia trait
3. Sideroblastic anemia
4. Anemia of chronic disease
5. Lead poisoning
6. Copper deficiency
7. Malnutrition

49. DDX of Microcytosis
Iron deficiency anemia Familial telangiectasia (OWR)
idiopathic pulmonary
hemosiderosis, PNH
 - thalassemia No simple test, trial of iron therapy
 - thalassemia  Thal minor - elevated Hb A2 if not
iron deficient
Anemia of chronic disease MCV 75-82; inadequate
erythropoietin response
Hb CC African-American, splenomegaly,
mild anemia MCV 65, many target
cells
Hb EE Southeast Asian, no anemia or
minimal anemia. MCV 65 many
target cells

50. Approach to Dx
• Hx- age,sex,pica,infection, duration, onset, subjacent
illness, blood loss (GI, menstruation, surgery…), diet,
medications, toxic exposure, occupation, Family Hx,
Social Hx
• PE- complete exam including skin (jaundice, petechiae),
HEENT, Abdomen (hepatosplenomegally), lymphatics,
rectal, and pelvic

51. P/E
1. Skin Pallor
Jaundice
Purpura
Hyperpigmentation
2. Skeletal deformity
3. Eye manifestations
4. Angular cheilosis
5. Atrophic glositis
6. Microcephaly
7. Splenomegaly
8. Spoon nail

52. Urinalysis
• Protein: light chains are not detected by dipstick
• RBC
• Hemoglobin

53. Cabot rings
(RNA or protein precipitation artifact don’t
confused with malaria)

54. Golf-ball pattern
(Hb H inclusions)

55. Ringed Sideroblasts in
BM
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Prussian Blue Stain

56. Macrocytosis -MBA
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57. Anisocytosis - Macrocytic
Anaemia
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58. HSN - MBA
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59. HSN - MBA
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60. Spherocytosis
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61. Elliptocytes
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Hereditary Elliptocytosis, B12 or Folate↓

62. Stomatocytes
Slit like central pallor in RBC
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1. Liver Disease
2. Acute Alcoholism
3. H Stomatocyosis
4. Malignancies

63. Echinocytes
Evenly distributed spicules > 10
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1. Uremia
2. Peptic ulcer
3. Gastric Ca
4. PK-D
Called Burr Cells

64. Acanthocytes
5-8 spikes of varying length, irregular
intervals
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Called Spur Cells, Occur in A H A

65. Shistocytes
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1. MAHA
2. Prosthetic valves
3. Uremia
4. Malignant HT
Fragmented, Helmet or triangle shaped RBC

66. Pelger-Huet Anomaly
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• Inherited condition
• PMN - Spectacles
• Heterozygous
• Homozygous fatal
• Neutrophil Bands ↑
• Normal WCC
• No e/o infection

67. Tear Drop Cells
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1. Myelofibosis
2. Infiltration of BM
3. Tumours of BM
4. Thalassemia

68. Hair on end -
Thalassemia Major
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69. Sickle Cell Anaemia
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70. Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.
Schrier, S. ASH Image Bank 2002;2002:100325
Figure 1. Note the profound central pallor of the hypochromic and microcytic RBC

71. Lab Test for DDx of Common Microcytic Hypochromic Anemias
Iron
Deficiency
Thalassemia
Minor
Chronic
Disease
Scrum Iron  N or  
TIBC  N or  N or 
% Iron
Saturation
 (< 10%) N or  
Serum Feritin   
FEP  N 

72. Hemolytic anemias
•Coomb’s test direct negative, indirect positive = delayed
transfusion reaction
•Hereditary spherocytosis
•Osmotic fragility test: fresh and incubated
•Autosomal dominant, spectrin decreased, splenectomy
•Sickle cells
•Sickledex- solubility screening test for hgb S
•Cellulose acetate electrophoresis necessary to define AS, SS, SC, S-
thal etc
•Elliptocytes
•Most are not anemic or have compensated hemolytic process
•10-15% have chronic hemolytic anemia

73. Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.
Schrier, S. ASH Image Bank 2002;2002:100344
Figure 5. This patient has hereditary elliptocytosis

74. Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.
Schrier, S. ASH Image Bank 2001;2001:100248
No Caption Found

75. Hemolytic anemias
•Acanthocytes
•Spurr cells- end stage liver disease- fatal prognosis
•Burr cells
•Uremia, PK deficiency
•Target cells
•High degree (30-100%) Hg CC, Hb EE, Hb SC, S-β-thal

76. Hemolytic anemias
•RBC enzyme defects
•G6PD deficiency-X linked, NSHA, Favism, Spot test
•Pyruvate kinase and other enzyme defects
•Autosomal recessive, for most
•Chronic hemolytic anemia
•Specific enzyme assays
•Intravascular hemolysis
•Serum haptoglobin
•Urine hemosiderin-useful 1-3 weeks after episode of
intravascular hemolysis

77. Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.
Schrier, S. ASH Image Bank 2001;2001:100226
Figure 1. Note the "bite cells" and the cells with "blisters" and dense cross-bonded
hemoglobin

78. Hemolytic anemias
•Causes of chronic intravascular hemolysis
•Cardiac abnormalities, usually prosthetic valve
•PNH
•PNH- paroxysmal nocturnal hemoglobinuria
•Sucrose hemolysis test
•Acid serum hemolysis test (Ham’s test)
•Flow cytometry for CD55, CD59

79. Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.
Schrier, S. ASH Image Bank 2001;2001:100231
Figure 2. Note the hypersegmented neutrophil (7-8 lobes)

80. RBC morphology
•7-9 m with 1/3 central palor
•Lifespan of 110-120 days
•About the size of nucleus of normal lymphocyte
•Poikilocytosis & Anisocytosis

81. Basophilic stippling
•Precipitated RNA
•lead or heavy metal
poisoning
•ETOH abuse
•Hemolytic anemia

82. Burr cells
•Altered lipid in cell
membrane
•artifact
•Uremia
•Renal failure
•gastric CA
•transfused old blood

83. Elliptocytes/ovalocytes
•Abnormal cytoskeletal
proteins
•Hereditary elliptocytosis

84. Howell Jolly body
•Nuclear remnant - DNA
•hemolytic anemia
•absent or hypofunction
spleen

85. Schistocyte/helmet cells
•Fragmented (mechanical or
phagocytosis)
•DIC
•TTP
•HUS
•Vasculitis
•prosthetic heart valve
•severe burns

86. Sickle cells
•Molecular aggregation of
Hgb-S
•SS, SC, S-thal
•rarely S-trait

87. NRBC
•Common in newborn
•severe degree of hemolysis

88. Spherocyte
•Absent central palor
•look smaller
•Hereditary spherocytosis
•immune hemolytic anemia

89. Stomatocyte
•Mouth like
•Membrane defect
•Smear artifact
•Hereditary stomatocytosis
•Liver disease

90. Target cells
•Increased redundancy of
membrane
•hemoglobinopathies
•thalassemia
•liver disease

91. Tear drop cells
•Distorted drop shaped
•Smear artifact
•myelofibrosis
•promyeloblastic leukemia
•space occupying lesions of
marrow

92. Sideroblastic anemia
•Accumulation of
mitochondrial iron in
erythroblasts
•Hereditary
•Drugs - INH, lead, zinc,
alcohol, chloramphenicol,
cycloserine, plavix
•Hypothermia
•Confirm w/ BM Bx

93. Anemia of chronic
disease
•Infections: TB, SBE,
osteo, chronic UTI or
pyelo, fungal
•Malignancy: mets,
leukemia, lymphoma,
myeloma
•Chronic inflammatory
disorders: RA, SLE,
Sarcoid, collagen
vascular disease,
polymyalgia rheumatica,
chronic hepatitis,
decubitus ulcer

94. Coombs’ positive with Spherocytes
Autoimmune hemolytic anemia
Warm AIHA
•Abrupt onset
•IgG
•Anti-Rh, e, C, c, LW, U
•Jaundice
•Splenomegaly
•SLE, CLL, Lymphoma
•Drugs: methyl-dopa,
mefenamic acid,
cimetidine, cefazolin
Cold AIHA
•Insidious onset
•IgM, complement
•Anti-I, I, Pr
•Cold agglutinin titer
•Absent jaundice
•Mycoplasma
•Virus

95. Coombs’ positive with Spherocytes
Other immune hemolytic anemia
Alloantibody hemolytic anemia
•Transfusion reaction
•Feto-maternal incompatibility (Kleihauer-Betke test)
Drug related Hemolytic anemia
•Toxic immune complex (drug+Ab+C3)
- Quinine, Quinidine, Rifampin, INH, Sulfonamides,
Tetracyclin
•Hapten formation (anti-IgG)
- PCN, methicillin, ampicillin

96. Coombs’ Negative
Hemolytic anemia
•Episodic - G6PD def., PNH
•Hemoglobinopathy
- Sickle, crystals or target cells
•Elliptocytosis
•Spherocytosis
•DIC, TTP

97. Coombs’ Negative Hemolytic Anemia
Membrane Defects
Spherocytosis
•Common among Northern
European
•Autosomal dominant
•Decreased spectrin
•Osmotic fragility test
•Autohemolysis test
Elliptocytosis
•90% with no clinically
significant hemolysis
•Abnormal membrane
protein

98. Coombs’ Negative Hemolytic Anemia
Deficiency of RBC Enzymes
Pyruvate Kinase Def.
•Severe anemia in
newborns
•Adults symptomatic
•Jaundice
•Splenomegaly
•Fluorescent screening test
•Quantitative test
G6PD Def.
•X-linked
•Mediterranean, African
American, and Asian
•Oxidant drugs – ASA, quinine,
primaquine, chloroquine,
sulfacetamide, sulfamethoxazole,
nitrofurantoin, chloramphenicol,
procainamide, quinidine
•Infections
•Quantitative test

99. Coombs’ Negative Hemolytic Anemia
Hemoglobinopathy
HbS disease
•Valine substitution for
Glutamic acid at the 6th
position of b-chain
•Sickle crises
•Severe anemia
•Screening test - Na
Metabisulfite solubility
•Hgb electrophoresis

100. Coombs’ Negative Hemolytic Anemia
Hemoglobinopathy continues
HbC disease
•Mild hemolysis
•Splenomegaly
•Lysine substitution
•HbC crystals “bar of gold”
•Hgb electrophoresis
HbSC disease
•Sickle and SC crystals
“Washington monument”
•Less crises
•More retinopathy/aseptic
necrosis

101. Coombs’ Negative Hemolytic Anemia
Paroxysmal Nocturnal Hemoglobinuria
•Rare chronic condition
•Recurrent abdominal pain, vomiting, headaches, eye pain,
thrombophlebitis
•Episodic Hgb in urine, Hemosiderinuria
•Abnormal cell membrane - increased lysis by complement
•Screening - Sucrose hemolysis test
•Confirm - Acid hemolysis test (Ham’s test)

102. Coombs’ Negative Hemolytic Anemia
Fragmented RBC’s & Thrombocytopenia
TTP-HUS
•Thrombocytopenia
•Microangiopathic hemolytic
anemia
•Neurologic symptoms and signs
•Renal failure
•Fever
•Idiopathic - 37 %
Drug-associated - 13 %
Autoimmune disease - 13 %
Sepsis - 9 %
Pregnancy - 7 %
Bloody diarrhea - 6 %
Hematopoietic cell
transplantation - 4 %
DIC
•Depletion of clotting factor
(TTP – normal)
•Thrombocytopenia
•Bleeding (64%)
•Renal dysfunction (25%)
•Hepatic dysfunction (19%)
•Respiratory dysfunction (16%)
•Shock (14%)
•Thromboemboli (7%)
•Central nervous system involvement
(2%)
•Sepsis, trauma, malignancy

103. IDA Summary
•MicrocyticMCV < 80 fl, RBC < 6 µ
•RDWWidened and shift to left
•HypochromicMCH < 27 pg, MCHC < 30%
•RPI< 2
•Retic. countMay be > 2 %
•Serum ferritinVery low < 30 (p mols/L)
•TIBCIncreased > 400 (µg/dL)
•Serum IronVery low < 30 (µg/dL)
•BM Fe StainAbsent Fe
•Response to Fe Rx.Excellent
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104. Anaemia of Chronic
Disease
•Thyroid diseases
•Malignancy
•Collagen Vascular Disease
•Rheumatoid Arthritis
•SLE
•Polymyositis
•Polyarteritis Nodosa
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• IBD
– Ulcerative Colitis
– Crohn’s Disease
• Chronic Infections
– HIV, Osteomyelitis
– Tuberculosis
• Renal Failure

105. Hemolytic Anaemia
Anemia of increased RBC destruction
– Normochromic, normocytic anemia
– Shortened RBC survival
– Reticulocytosis – due to ↑ RBC destruction
Will not be symptomatic until the RBC life span is
reduced to 20 days – BM compensates 6 times
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106. Tests Used to Diagnose Hemolysis
.1Reticulocyte count
.2Combined with serial Hb
.3Serum LDH
.4Serum bilirubin
.5Haptoglobin
.6Urine hemosiderin
.7Hemoglobinuria
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107. Findings in Hemolytic
Anaemia
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Reticulocyte count and RPI Increased
Serum Unconjugated Bilirubin Increased
Serum LDH 1: LDH 2 Increased
Serum Haptoglobin Decreased
Urine Hemoglobin Present
Urine Hemosiderin Present
Urine Urobilinogen Increased
Cr 51 labeled RBC life span Decreased

108. Tests to define
the cause of hemolysis
.1Hemoglobin electrophoresis
.2Hemoglobin A2 (βeta-Thalassemia trait)
.3RBC enzymes (G6PD, PK, etc)
.4Direct & indirect antiglobulin tests (immune)
.5Cold agglutinins
.6Osmotic fragility (spherocytosis)
.7Acid hemolysis test (PNH)
.8Clotting profile (DIC)
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