Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Fatigue, pallor, jaundice• Splenomegaly• Persistent anemia and reticulocytosis +++ Epidemiology + • Autoimmune disorder that is either idiopathic (40-50%) or secondary to drug exposure, connective tissue diseases, or lymphoproliferative disorders• Classified according to the optimal temperature at which autoantibodies react with the red cell surface (warm or cold antibodies) -Warm antibody: IgG autoantibodies directed against the Rh locus on the erythrocyte coat the cell and bind to IgG specific Fc receptors on macrophages in the spleen-Cold antibody: IgM autoantibodies are directed against the I red cell antigen; hemolysis occurs intravascularly and not within the spleen• Most common after age 50; occurs twice as often in women than in men +++ Symptoms and Signs + • Fatigue• Mild jaundice• Fever• Splenomegaly +++ Laboratory Findings + • Acute onset normocytic normochromic anemia• Reticulocytosis (> 10%)• Erythroid hyperplasia of the marrow• Elevation of serum indirect bilirubin• Serum haptoglobin is usually low or absent• Positive direct Coombs test + • Rarely, a sudden, severe onset hemolytic anemia produces hemoglobinuria, renal tubular necrosis, and a 40-50% death rate• May be associated with systemic lupus erythematosus and chronic lymphocytic leukemia• Drugs commonly implicated include methyldopa, penicillin, quinidine +++ Rule Out + • Other causes of hemolytic anemia-Hereditary hemolytic anemias-Thrombotic thrombocytopenic purpura-Disseminated intravascular coagulation-Infection + • CBC count• Serum bilirubin• Reticulocyte count• Peripheral blood smear• Serum haptoglobin• Bone marrow biopsy• Coombs test +++ When to Admit + • Severe anemia +++ When to Refer + • All cases should be managed in conjunction with a hematologist + • Drug-induced hemolytic anemia: Terminate exposure to the agent. +++ Surgery + • Splenectomy is indicated for patients with warm-antibody hemolysis meeting the following criteria: +++ Indications + • Failure to respond to 4-6 weeks of high-dose corticosteroid therapy• Relapse when corticosteroids are withdrawn• Contraindications to corticosteroid therapy• Chronic high-dose corticosteroid therapy +++ Contraindications + • Cold-antibody hemolytic anemia +++ Medications + • Corticosteroids• IV immune globulin +++ Treatment Monitoring + • CBC count +++ Complications + • Pigment gallstones +++ Prognosis + • 75% remission rate with medical treatment; 25% are permanent• Relapses may occur after splenectomy +++ References ++Beutler E et al. Hemolytic anemia. Semin Hematol. 1999;36:38. [PubMed: 10595753] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth