Diagnostic Tests

• Blood
• Complete Blood Count.
• Reticulocyte count.
• Peripheral smear.
• Coombs' test.
• Lactate dehydrogenase (LDH)
• Haptoglobin, bilirubin(esp. indirect), and liver function tests.
• Hemoglobin electrophoresis.
• Paroxysmal nocturnal hemoglobinuria (PNH).
• Osmotic fragility test.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Urine Test - presence of free hemoglobin and iron.
• Bone Marrow Tests
• Bone marrow aspiration,
• Bone marrow biopsy
Other conditions
• Kidney failure
• Lead poisoning
• Vitamin or iron deficiency
Red blood cell indices
• A low mean corpuscular volume (MCV) and mean corpuscular
hemoglobin (MCH) are consistent with a microcytic hypochromic
anemia due to iron deficiency that may occur in chronic intravascular
hemolysis.
• Folate consumed during chronic hemolysis may lead to
megaloblastosis and a high MCV.
• A high MCH and mean corpuscular hemoglobin concentration (MCHC)
would suggest spherocytosis
Red blood cell distribution width
• Red blood cell distribution width
• An increased RDW is a measure of anisocytosis that can occur in hemolytic
anemias.
• Reticulocyte count
• An increased reticulocyte count represents increased RBC production and is a
criterion for hemolysis but is not specific for hemolysis.
• The reticulocyte count may be normal or low in patients with bone marrow
suppression despite ongoing severe hemolysis (aplastic crisis).
Peripheral Blood Smear
• Polychromasia indicates RBC immaturity
• Concomitant underlying hematologic malignancy associated with
hemolysis
• Spherocytes, suggesting congenital spherocytosis or autoimmune
hemolytic anemia (AIHA)
• The presence of schistocytes (fragmented red blood cells) suggests
TTP, HUS, or mechanical damage
• Lactate Dehydrogenase
• LDH elevation is sensitive for hemolysis, but is not specific
• LDH isozymes 1 and 2 is more specific for red blood cell but can found in
myocardial infarction
• Haptoglobin
• A low serum haptoglobin level is a criterion for moderate-to-severe hemolysis. A
decrease in serum haptoglobin is more likely in intravascular hemolysis than in
extravascular hemolysis. It is an acute phase reactant.
• Indirect Bilirubin
• Unconjugated bilirubin is a criterion for hemolysis, but not specific
• The level of indirect bilirubin usually is less than 3 mg/dL
• Coombs test/ Direct antiglobulin test
• DAT result is usually positive in autoimmune hemolytic anemia
(AIHA), but it may occasionally be negative in this disorder.
• From 5-10% of all AIHAs are DAT negative. The polybrene test can
detect DAT-negative AIHA.
• In addition, the immunoradiometric assay (IRMA) for red blood cell–
bound IgG can be used to diagnose AIHA in patients whose
autoantibody levels are too low to be detected by conventional DAT.
• DAT-negative AIHA has a better prognosis than DAT-positive AIHA
• Urine
• Hemoglobinuria occurs when the amount of free hemoglobin released during hemolysis
exceeds available haptoglobin
• Urine hemosiderin reflects hemoglobinuria and suggests severe or intravascular
hemolysis.
• Red blood cell survival (chromium-51 [51 Cr] survival)
• rarely used, but it can definitively demonstrate shortened red blood cell survival
(hemolysis).
• The cold agglutinin
• Cold agglutinin titer will be elevated in cold agglutinin disease, with the specific IgM
antibody varying according to the underlying disorder.( a high titer of anti-I antibody
occurs in mycoplasmal infections ,on fetal cord blood RBCs in infectious mononucleosis.
• G6PD screening
• can usually detect deficiency of this enzyme, but results can be normal if the
reticulocyte count is elevated (reticulocytes contain a considerable amount of
G6PD).
• A positive Heinz body preparation can suggest denatured hemoglobin and
thus G6PD deficiency
Sumber :
• Source: National Heart, Lung, and Blood Institute, National Institutes
of Health.