Hemolytic anemia Normocytic

• Facts:
  Bone marrow production is unable to compensate for increased destruction of circulating blood cells
• History / PE:
  Pallor, fatigue
  Tachycardia, tachypnea
  Jaundice
  Hemoglobinuria
• Diagnosis:
  Elevated reticulocyte count
  High LDH
  Elevated indirect bilirubin
  Decreased haptoglobin levels
  COOMBS' test (autoimmune hemolysis)
• Treatment:
  Corticosteroids
  Iron supplementation
• Differential Diagnosis:
  1) G6PD deficiency (increased RBC sensitivity to stress) and pyruvate kinase deficiency
  
  2) Paroxysmal nocturnal hemoglobinuria (increased sensitivity to complement activation)
  
  3) Hereditary spherocytosis
  
  4) Autoimmune hemolytic anemia (eg. CLL, Non- hodgkin's lymphoma , EBV infection, mycoplasmal infection, rheumatoid disease, or medications)
  
  5) Sickle cell disease
  
  6) Microangiopathic hemolytic anemia (TTP, HUS, DIC)
  
  7) Mechanical hemolysis (mechanical heart valves)
  
  8) Other (eg. malaria , hypersplenism)