Common causes of hemolysis and hemolytic anemia in adults

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Common causes of hemolysis and hemolytic anemia in adults

Non-immune causes

Hereditary
Enzyme deficiencies (eg, deficiencies of G6PD, pyruvate kinase, glucose-phosphate isomerase, 5'
nucleotidase)

Hemoglobinopathies (eg, sickle cell disease, thalassemias, unstable hemoglobins)

Membrane defects (eg, hereditary spherocytosis, hereditary elliptocytosis, hereditary

stomatocytosis)

Acquired

Liver disease

Hypersplenism

Infections (eg, Bartonella, Babesia, malaria, clostridial sepsis)

Oxidant agents (eg, dapsone, nitrites, aniline dyes)

Toxins (eg, lead, copper, snake and spider bites)

Infusion of a hypotonic solution

Microangiopathic hemolytic anemia (eg, TTP, HUS, aortic stenosis, prosthetic valve leak)

Immune causes
Warm autoimmune hemolytic anemia

Drug-induced immune hemolysis

Transfusion reactions (eg, ABO incompatibility, alloantibodies)

Paroxysmal cold hemoglobinuria

Paroxysmal nocturnal hemoglobinuria

Cold agglutinin disease

Intravenous infusion of IVIG or anti-RhD immune globulin

Non-immune causes generally have a negative Coombs test (also called direct antiglobulin test [DAT]);
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Common causes of hemolysis and hemolytic anemia in adults
immune causes are typically DAT-positive. Refer to UpToDate for an approach to the evaluation. Any
form of hemolytic anemia can lead to an underestimation of the hemoglobin A1C (HbA1C).

G6PD: glucose-6-phosphate dehydrogenase; TTP: thrombotic thrombocytopenic purpura; HUS:

hemolytic uremic syndrome; IVIG: intravenous immune globulin.

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