Hemolytic Anemias
Mechanism | Disorder or Agent |
|---|---|
Disorders extrinsic to the red blood cell | |
Immunologic abnormalities | Autoimmune hemolytic anemias:
Transfusion reactions (alloantibody-mediated) |
Infectious organisms (direct invasion) | Babesia Bartonella bacilliformis Plasmodium falciparum P. malariae P. 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 or complement-mediated hemolytic uremic syndrome, hemolytic uremic syndrome (shiga toxin-mediated) Disorders with microangiopathic hemolytic anemia and thrombocytopenia, often considered secondary TMAs, including transplant-associated TMA, HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) syndrome, autoimmune TMA (eg, associated with SLE, catastrophic antiphospholipid syndrome, scleroderma renal crisis), drug-Induced TMA, or related to severe hypertension, infection, or malignancy |
Reticuloendothelial hyperactivity | |
Toxin production by infectious organisms | Clostridium perfringens Shiga toxin |
Toxins | 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 | |
Disorders of hemoglobin synthesis | 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) |