Diagnostic Framework for Hemolysis - Intravascular vs Extravascular Causes

Intravascular Hemolysis:

 • Mechanical Trauma (Microangiopathic hemolytic anemia): 

    - Disseminated intravascular coagulation (DIC)

    - HELLP syndrome

    - Thrombotic microangiopathy: Thrombotic thrombocytopenic purpura (TTP), Hemolytic uremic syndrome (HUS)

 • Other: Transfusion reaction, Paroxysmal nocturnal hemoglobinuria (PNH)

Extravascular Hemolysis:

 • Immune-mediated: 

    - Autoimmune (AIHA) "Warm" (usually IgG) (e.g. lupus, CLL, lymphoma, idiopathic)

    - Autoimmune (AIHA)"Cold" (usually IgM) (e.g. primary cold agglutin disease, lymphoproliferative disorders, Mycoplasma pneumoniae infection)

    - Drugs (Beta lactam antibiotics are the most frequently implicated)

    - Transfusion reaction

 • Intrinsic RBC Defects: Enzyme deficiencies (e.g. G6PD deficiency), Hemoglobinopathies (e.g. sickle cell disease, thalassemias), Membrane defects (e.g. hereditary spherocytosis)

 • Infections: Malaria, Babesiosis

 • Other: Hypersplenism, Wilson's disease, Copper and lead poisoning



- Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/



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