King's College Hospital, London, UK
King's College Hospital, London, UK.
Clin Med (Lond). 2022 May;22(3):210-213. doi: 10.7861/clinmed.2022-0142.
Haemolytic anaemia can seem like a complicated topic. The constellation of reticulocytosis, increased lactate dehydrogenase levels, increased unconjugated bilirubin levels and decreased haptoglobin levels should prompt general physicians to consider haemolysis as a differential diagnosis. When further approaching haemolytic anaemia, subdividing patients into those who are 'direct antiglobulin test (DAT) positive' (immune) or 'DAT negative' (non-immune) is a simple and clinically relevant way to start to formulate a cause for the haemolytic anaemia. Immune causes of haemolytic anaemia include autoimmune haemolytic anaemia, drugs and delayed haemolytic transfusion reactions. Non-immune causes include the haemoglobinopathies (such as sickle cell disease) and microangiopathic haemolytic anaemias (such as disseminated intravascular coagulation). Early supportive care in haemolytic anaemia is important and may involve blood transfusions as well as interventions to slow the rate of haemolysis, such as steroids in autoimmune haemolytic anaemia. Complications of haemolysis include pigment gallstones, high-output cardiac failure and thromboembolism. Haemolytic anaemia should be referred to the haematologist for further investigation, however, the recognition and early management by the general physician is imperative in improving the patient's outcome.
溶血性贫血可能看起来是一个复杂的话题。网织红细胞增多、乳酸脱氢酶水平升高、未结合胆红素水平升高和结合珠蛋白水平降低的组合应该促使全科医生将溶血作为鉴别诊断。当进一步探讨溶血性贫血时，将患者分为“直接抗球蛋白试验（DAT）阳性（免疫性）”或“DAT 阴性（非免疫性）”是一种简单且具有临床相关性的方法，可用于确定溶血性贫血的病因。溶血性贫血的免疫原因包括自身免疫性溶血性贫血、药物和迟发性溶血性输血反应。非免疫原因包括血红蛋白病（如镰状细胞病）和微血管性溶血性贫血（如弥散性血管内凝血）。溶血性贫血的早期支持性护理很重要，可能包括输血以及干预以减缓溶血速度，如自身免疫性溶血性贫血中的类固醇。溶血的并发症包括色素性胆石症、高输出性心力衰竭和血栓栓塞。溶血性贫血应转介给血液科医生进一步检查，但全科医生的识别和早期管理对于改善患者的预后至关重要。
