Hemolytic Anemias

Hemolytic Anemias

Mechanism

Disorder or Agent

Disorders extrinsic to the red blood cell

Immunologic abnormalities

Autoimmune hemolytic anemias:

Infectious organisms (direct invasion)

Babesia

Bartonella bacilliformis

Plasmodium falciparum

Plasmodium malariae

Plasmodium vivax

Mechanical trauma

Disseminated intravascular coagulation (DIC)

Extracorporeal membrane oxygenation (ECMO)

March hemoglobinuria

Valvular heart disorders and mechanical valves

Ventricular assist devices

Primary thrombotic microangiopathies (TMA), including thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome (complement-mediated TMA), hemolytic uremic syndrome (Shiga toxin-mediated)

Secondary TMAs (ie, disorders manifesting with microangiopathic hemolytic anemia and thrombocytopenia as well as organ damage), including transplant-associated TMA, HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) syndrome/preeclampsia with severe features, autoimmune TMA (eg, associated with systemic lupus erythematosus, catastrophic antiphospholipid syndrome, scleroderma renal crisis), drug-Induced TMA, or related to severe hypertension, infection, or malignancy

Reticuloendothelial hyperactivity

Hypersplenism

Toxin production by infectious organisms

Clostridium perfringens

Shiga toxin

Toxins

Compounds with oxidant potential (eg, dapsone, phenazopyridine, naphthalene), well waterCompounds with oxidant potential (eg, dapsone, phenazopyridine, naphthalene), well water

Copper (Wilson disease)

Lead

Insect venom

Snake venom

Thermal injury

Associated with burns

Intrinsic red blood cell abnormalities

Acquired red blood cell membrane disorders

Severe hypophosphatemia (depletion of adenosine triphosphate [ATP])

Paroxysmal nocturnal hemoglobinuria

Stomatocytosis

Spur cell anemia (acanthocytosis)

Congenital red blood cell membrane disorders

Hereditary elliptocytosis

Hereditary spherocytosis

Hereditary stomatocytosis

Disorders of hemoglobin synthesis

Hemoglobin C disease

Hemoglobin E disease

Sickle cell disease

Thalassemias

Unstable hemoglobins

Disorders of red blood cell metabolism

Glycolytic pathway defects (eg, pyruvate kinase deficiency)

Hexose monophosphate shunt defects (eg, glucose-6-phosphate dehydrogenase [G6PD] deficiency)