Acquired hemolytic anemia

Acquired hemolytic anemia can be divided into immune and non-immune mediated forms of hemolytic anemia.

Immune

Immune mediated hemolytic anaemia (direct Coombs test is positive)

• Autoimmune hemolytic anemia
  • Warm antibody autoimmune hemolytic anemia
    • Idiopathic
    • Systemic lupus erythematosus (SLE)
    • Evans' syndrome (antiplatelet antibodies and hemolytic antibodies)
  • Cold antibody autoimmune hemolytic anemia
    • Idiopathic cold hemagglutinin syndrome
    • Infectious mononucleosis and mycoplasma (atypical) pneumonia
    • Paroxysmal cold hemoglobinuria (rare)
• Alloimmune hemolytic anemia
  • Hemolytic disease of the newborn (HDN)
    • Rh disease (Rh D)
    • ABO hemolytic disease of the newborn
    • Anti-Kell hemolytic disease of the newborn
    • Rhesus c hemolytic disease of the newborn
    • Rhesus E hemolytic disease of the newborn
    • Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, MN, P and others)
  • Alloimmune hemolytic blood transfusion reactions (i.e., from a non-compatible blood type)
• Drug induced immune mediated hemolytic anemia
  • Penicillin (high dose)
  • Methyldopa

Non-immune

Non-immune mediated hemolytic anemia (direct Coombs test is negative)

• Drugs (i.e., some drugs and other ingested substances lead to hemolysis by direct action on RBCs, e.g., ribavirin )
• Toxins (e.g., snake venom; plant poisons such as aesculin)
• Trauma
  • Mechanical (from heart valves, extensive vascular surgery, microvascular disease, repeated mechanical vascular trauma)
• Microangiopathic hemolytic anaemia (a specific subtype with causes such as TTP, HUS, DIC and HELLP syndrome)
• Infections (Note: Direct Coombs test is sometimes positive in hemolytic anaemia due to infection)
  • Malaria
  • Babesiosis
  • Sepsis
• Membrane disorders
  • Paroxysmal nocturnal hemoglobinuria (rare acquired clonal disorder of red blood cell surface proteins)
  • Liver disease

Drug induced hemolysis

Drug induced hemolysis has large clinical relevance. It occurs when drugs actively provoke red blood cell destruction. It can be divided in the following manner:

• Drug-induced autoimmune hemolytic anemia
• Drug-induced nonautoimmune hemolytic anemia

A total of four mechanisms are usually described, but there is some evidence that these mechanisms may overlap.

References

External links

1. Hemolytic anemia
2. Autoimmune hemolytic anemia
3. Microangiopathic hemolytic anemia
4. Warm antibody autoimmune hemolytic anemia
5. Hemolysis
6. Hemolytic–uremic syndrome
7. Cold autoimmune hemolytic anemia
8. Drug-induced autoimmune hemolytic anemia
9. Mechanical hemolytic anemia
10. Hemolytic disease of the newborn
11. Cold agglutinin disease
12. Paroxysmal cold hemoglobinuria
13. Rh disease
14. Spur cell hemolytic anemia
15. Paroxysmal nocturnal hemoglobinuria
16. Hemolytic jaundice
17. Aplastic anemia
18. Thrombotic microangiopathy
19. Hemolytic disease of the newborn (anti-Kell)
20. Hemolytic disease of the newborn (ABO)