Haptoglobin values are therefore low in hemolytic anemia. Microangiopathic hemolytic anemia is intravascular hemolysis caused by excessive shear or turbulence in the circulation. Obtain peripheral blood smear and DAT (“direct Coombs” – though the lab never refers to this test by that name) ASAP If peripheral smear suggests hereditary hemolytic anemia due to hemiglobinopathy, metabolic defect or membrane defect, then more specific testing should be pursued; spherocytes or schistocytes support active hemolytic process These include assessment of RBC shape, size, color, inclusions, and arrangement. The severity of the anemia depends on whether the onset of hemolysis is gradual or abrupt and on the extent of erythrocyte destruction. This test is called a peripheral blood smear. A peripheral blood smear should be performed when hemolysis is present to identify abnormal red blood cell morphologies. Peripheral Smear • Inexpensive, rapid, reliable • Window into the functional status of the bone marrow –especially cytopenic states . Hemolysis is the premature destruction of erythrocytes. Hereditary spherocytosis and autoimmune hemolytic anemia are characterized by having only spherocytes. ... compensated hemolytic anemia • Disease processes include muscular dystrophy, cardiomyopathy, and “neuroacanthosis” • May be associated with chronic Hemolytic diseases are classified into hemoglobinopathies, membranopathies, enzymopathies, immune-mediated anemias, and extrinsic nonimmune causes. The average lifespan of a red blood cell is 120 days. The peripheral smear usually shows microspherocytes and a high reticulocyte count with few or no schistocytes, indicating extravascular hemolysis. Hemolytic anemia describes a large group of conditions characterized by accelerated destruction of red blood cells. The peripheral smear and reticulocyte count are the most important tests to diagnose hemolysis. At the end of 120 days, the red blood cell is broken down and the parts of it are recycled to make new ones. In patients with anemia, the peripheral smear permits interpretation of diagnostically significant red blood cell (RBC) findings. Certain straightforward conditions such as iron deficiency anemia can be easily diagnosed on the basis of clinical information and basic laboratory data … Review of the peripheral smear is not required in all patients with a hematological disorder. The foundation of laboratory hematologic diagnosis is the complete blood count and review of the peripheral smear. If hemolysis is suspected, a peripheral smear is examined and serum bilirubin, LDH, haptoglobin, and ALT are measured. Hemolysis is suspected in patients with anemia and reticulocytosis. (See also Overview of Hemolytic Anemia .) A hemolytic anemia will develop if bone marrow activity cannot compensate for the erythrocyte loss. Hemolytic anemia also leads to increased values of lactate dehydrogenase (LDH) in the blood, as it is released from destroyed red blood cells. … Mild anemia (hematocrit 11 g/dl) with microcytosis, reticulocytosis, and a peripheral smear consistent with a xerocytic type of hemolytic anemia were accompanied by homozygosity for hemoglobin E, a clinically benign hemoglobin frequently encountered in Southeast Asia. Haptoglobin is a hemoglobin scavenger that gets consumed when increased values of hemoglobin are released in the blood due to hemolysis. Spherocytosis is the presence in the blood of spherocytes, i.e erythrocytes (red blood cells) that are sphere-shaped rather than bi-concave disk shaped as normal.Spherocytes are found in all hemolytic anemias to some degree. Autoimmune hemolytic anemia should be suspected in any patient with a hemolytic anemia (as suggested by the presence of anemia and reticulocytosis).
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