Clinical Applications of Hemolytic Markers in the Differential Diagnosis and Management of Hemolytic Anemia

W. Barcellini, B. Fattizzo

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Several hemolytic markers are available to guide the differential diagnosis and to monitor treatment of hemolytic conditions. They include increased reticulocytes, an indicator of marrow compensatory response, elevated lactate dehydrogenase, a marker of intravascular hemolysis, reduced haptoglobin, and unconjugated hyperbilirubinemia. The direct antiglobulin test is the cornerstone of autoimmune forms, and blood smear examination is fundamental in the diagnosis of congenital membrane defects and thrombotic microangiopathies. Marked increase of lactate dehydrogenase and hemosiderinuria are typical of intravascular hemolysis, as observed in paroxysmal nocturnal hemoglobinuria, and hyperferritinemia is associated with chronic hemolysis. Prosthetic valve replacement and stenting are also associated with intravascular and chronic hemolysis. Compensatory reticulocytosis may be inadequate/absent in case of marrow involvement, iron/vitamin deficiency, infections, or autoimmune reaction against bone marrow-precursors. Reticulocytopenia occurs in 20-40% of autoimmune hemolytic anemia cases and is a poor prognostic factor. Increased reticulocytes, lactate dehydrogenase, and bilirubin, as well as reduced haptoglobin, are observed in conditions other than hemolysis that may confound the clinical picture. Hemoglobin defines the clinical severity of hemolysis, and thrombocytopenia suggests a possible thrombotic microangiopathy or Evans' syndrome. A comprehensive clinical and laboratory evaluation is advisable for a correct diagnostic and therapeutic workup of the different hemolytic conditions.

Original languageEnglish
Article number635670
JournalDisease Markers
Volume2015
DOIs
Publication statusPublished - 2015

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Hemolytic Anemia
Hemolysis
L-Lactate Dehydrogenase
Differential Diagnosis
Haptoglobins
Thrombotic Microangiopathies
Bone Marrow
Reticulocytes
Prosthetics
Bilirubin
Vitamins
Anti-Idiotypic Antibodies
Bone
Hemoglobins
Blood
Iron
Reticulocytosis
Membranes
Paroxysmal Hemoglobinuria
Avitaminosis

ASJC Scopus subject areas

  • Biochemistry, medical
  • Clinical Biochemistry
  • Molecular Biology
  • Genetics

Cite this

Clinical Applications of Hemolytic Markers in the Differential Diagnosis and Management of Hemolytic Anemia. / Barcellini, W.; Fattizzo, B.

In: Disease Markers, Vol. 2015, 635670, 2015.

Research output: Contribution to journalArticle

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