Anemia
Hemolytic anemia

  • CBC w/diff

    • Confirms anemia → ↓ Hgb

    • Normal (normocytic) → hemolysis, acute blood loss

    • ↓ platelets + hemolysis** → TTP,DIC,HUS

    • WBC count + Differential (- Neutrophils ↑ → infection, stress, Lymphocytes ↑ → viral, Eosinophils ↑ → allergy, parasites, Monocytes ↑ → chronic inflammation)
      Hemolysis labs

  • ↑ LDH → released from lysed RBCs

  • ↑ Indirect (unconjugated) bilirubin → heme breakdown

  • ↓ Haptoglobin → binds free Hb → gets consumed

  • ↑ Reticulocyte count → bone marrow response

  • peripheral smear

    • Schistocytes → MAHA (e.g., TTP, DIC, HUS)

    • Spherocytes → hereditary spherocytosis, autoimmune hemolytic anemia

    • Bite cells / Heinz bodies → G6PD deficiency

    • Sickle cells → sickle cell disease

  • Direct Antiglobulin Test (DAT / Coombs)

    • Positive → autoimmune hemolysis (warm/cold AIHA)

    • Negative → non-immune causes (MAHA, G6PD, etc.)

Step 1: Confirm hemolysis pattern

If you see:

  • ↑ LDH

  • ↑ indirect bilirubin

  • ↓ haptoglobin

  • ↑ retic

Step 2 : Immune vs Non-immune hemolysis

  • (Coombs) POSITIVE

    • Warm AIHA (IgG) - Smear: spherocytes

    • Cold agglutinin disease (IgM) - RBC clumping on smear

    • Drug-induced hemolysis

    • Transfusion reaction

Step 3 : Now smear drives everything:

  • Schistocytes → MAHA

    • TTP (↓ platelets, neuro, renal) 🚨

    • HUS (renal predominant)

    • DIC (↑ PT/PTT, ↓ fibrinogen)

    • Mechanical valves

  • Bite cells / Heinz bodies -> G6PD deficiency (triggered by infection, sulfa drugs, fava beans)

  • Spherocytes (DAT negative) -> Hereditary spherocytosis

  • Sickle cells

  • No clear smear findings-> PNH (check CD55/CD59), liver disease, Early hemolysis