Haemolytic Anaemia

Clinical features

• anaemia

• jaundice

• pigment gallstones

• splenomegaly

• ankle ulcers

  • sickle cell anaemia

  • thalassaemia intermedia

  • hereditary spherocytosis

• Expansion of marrow

  • leading to frontal bossing in children

• Aplastic crises

  • parvovirus

• megaloblastic anaemia

  • folate deficiency

Laboratory

• haemoglobin normal or reduced

• raised reticulocyte count

• Blood film

  • polychromasia

  • spherocytes

  • elliptocytes

  • sickle cells

  • fragmented cells

• Bone marrow

  • increased erythropoesis

• unconjugated bilirubin increased

• serum haptoglobins absent

• faecal stercobilinogen, urine urobilinogen

• radioactive measurement of red blood cell life span

  • predicts value of splenectomy

• Intravascular haemolysis

  • Raised plasma and urine haemoglobin

  • positive serum methaemoglobin (Shumm's test)

  • urine haemosiderin

Causes

Membrane

• Hereditary spherocytosis

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