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Osmotic

Fragility

RAPID

MEMBRA
NE

Benign
autoantib
ody

Haemolytic Transfusion reaction,


Haemolytic Newborn Disease,
Organ/Bone Marrow Transplant,

Drug
-

SC

Eluat

Haemol
ytic
Transfus
ion

War
m

SC
R

NC

Eluat

REDO

AC

+ve IgG/

+ve IgG/-ve

NEGATIV
E
IRM
A

PRESE
NT

Cold
AIH
A

POSITIV
E

Microangiopat
hic haemolytic

Spur

Hypochromic
microcytic

Hb
electrophor
esis

Elliptocyt
osis

Infection e.g.
malaria,
Oxidative

Elliptocy
tes

Erythrocyte
inclusions
Blister and bite

LOW

HIGH

Liver

Peripheral smear to
look for specific
diagnosis
POSITIV

NEGATIVE

Intercranial
bleeding

Cardiac
functio
n

Thrombotic
thrombocytop
enia purpura

Dissemina
ted
Intravascu
lar

Cant
find

Jaundi
ce

Asymptoma
tic

Anox
ia

Vit B12 assay


for

Complete Blood

cause
H
b
HIGH

Tests for other conditions: Kidney


failure, lead poisoning,
vitamin/iron deficiency.

Sickle
cells

IRMA:
Immunoradiometric
assay.
AIHA: Autoimmune
Haemolytic
anaemia.
ACR: All Cells
Reactive.
SCR: Some Cells
Reactive.
NCR: No Cells
Reactive.
RBC: Red Blood
Cell
Hct: Haematocrit
MCHC: mean

history present.
Familial history.
Recent illnesses or medical conditions.
Certain medications.
Exposure to certain chemicals or
substances.
Have an artificial heart valve or other

Urinary
bleeding

Ultrasonogra

Microcytic
hypochromic
anaemia

cells

Sickle cell
anaemia

Enlarged
Spleen

Red blood cell survival test


using Cr51 for definitive
haemolysis diagnosis
MCHC
+MCV

Schistocyt
es

TEST:
RESULT:
CONDITION:

Physical
examination

Chronic lymphocytic
leukemia (CLL).
Some lymphomas.
Systemic lupus
erythematosus (SLE).
Lymphadenopathy
hepatosplenomegaly
indicates an underlying
lymphoproliferative

Spherocyte

5-10%
AIHA
Thalassae
mia

G6P

Not
larg
e

-ve IgG/+ve

Direct Coombs

G6PD
Deficie
ncy

Do Mono-IgG and Mono C3


on EDTA blood

Hereditary
Spherocyt

Clinical
-

Positive
Heinz body
preparatio
n

Donath-Landsteiner
antibody
Drug-inducedImmune
Complex, Cold
AIHA,
Paryoxsymal
cold

No clinical
history

G6PD assay by
spectrophotom
etry

Drug-induced
absorption
mechanism,
Dialysis
Hypergammaglob
ulinaemia

NC

Review clinical
history

Fluorescent spot
test

Other specific
tests

AC

A DIAGNOSTIC APPROACH
TO A PATIENT SUSPECTED
WITH HAEMOLYTIC
ANAEMIA

NORMAL

SLOW

Liver
function
tests: e.g.
Increased

Consider other
diagnoses e.g chronic

Hc
t

Reticulocyt
e

RD
W

Spherocyto

Anae
mia

HIGH

Treatment of
iron/vit

Blood

Neutrophil
s

LDH,
Haptoglobulin,
unconjugated

Bone marrow
suppression
despite having
constant severe
haemolysis.

NORMAL/LO

AN
D

Panctope
nia

Myoglobin
Urine
test

Dark

Intravascular

Megalobl
astic
anaemia

Porphy
ria
Haemoglobin

Hemosideri

Urine
haemosiderin
Prussian blue
Urine
free Hb
test

Hb