Haemolytic Anaemia

Clinical Description

Anaemia due to increased destruction of red blood cells. Destruction may be due to extravascular or intravascular causes. Cause can be inherited or acquired.

Signs and Symptoms

• Evidence of haemolysis: anaemia, reticulocytosis, decreased haptoglobin, increased lactate dehydrogenase (lDH) and unconjugated hyperbilirubinaemia.

Investigations

• Coombs' test (direct antiglobulin) is usually positive with autoimmune haemolysis

Treatment

Efficacy of transfusion is limited by the shortened red cell survival due to haemolysis.

• Supplement with Folic acid, oral, 5 mg q24h given to all patients
• For Autoimmune haemolytic anaemia, give Prednisolone, oral, 1-2 mg/ kg q24h, When a satisfactory response is obtained with recovery of the haemoglobin and a decrease in LDH serum concentrations, taper dose over a period of 4 weeks to 30mg q24h.
• Thereafter reduction should be slower to prevent disease recurrence
• Prednisone treatment can be stopped when the Coombs' reaction becomes negative.
• If inadequate response add Azathioprine, oral, 2.5 mg/kg q24h. Titrate to Hb response. May be required for several months. Monitor for neutropenia.
• Patients who fail medicine treatment should be considered for splenectomy.

Complications

• Cholelithiasis
• Iron overload
• Transfusion related infections

Complications and Referral Criteria

• Suspected haemolytic anaemia
• Patients requiring further work up at tertiary facility
• No response to treatment