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TABLE 3 Acute Hemolytic Anemia: Presentation and Management
Cause Presentation Supporting Evidence Management
DIC History of underlying cause: sepsis, Normocytic anemia Evaluate and treat underlying cause
trauma, malignancy, heat stroke, Prolonged PT/aPTT Platelet transfusion (if <50,000/mm )
3
liver disease Elevated D-dimer Consider TXA if active bleeding
Fever Thrombocytopenia Consider FFP, cryoprecipitate transfusion
Petechiae/purpura Low fibrinogen
Bleeding
Thrombosis
HUS Bloody diarrhea Elevated SCr level Supportive care
Abdominal pain Thrombocytopenia Dialysis may be needed
Oliguria Schistocytes on peripheral smear Avoid antibiotics
Normal coagulation panel
TTP History of ADAMTS13 deficiency Elevated SCr level Plasma exchange
History of HIV, pregnancy, use of Thrombocytopenia Consider FFP while awaiting plasma exchange
acyclovir, clopidogrel, quinine Schistocytes on peripheral smear
Fever Normal coagulation panel
CNS abnormalities
Oliguria
GI bleed
AIHA Provoking medications: penicillin, Positive direct antiglobulin test Corticosteroids:
cephalosporins, NSAIDs, Spherocytes on peripheral smear IV methylprednisolone 100-200mg divided
hydrocortisone, isoniazid Normal coagulation panel over 24 h
Oral prednisone 60-100mg schistocytes causes
AIHA, autoimmune hemolytic anemia; aPTT, activated partial thromboplastin time; CNS, central nervous system; DIC, disseminated intravas-
cular coagulopathy; FFP, fresh-frozen plasma; GI, gastrointestinal; HIV, human immunodeficiency virus; HUS, hemolytic uremic syndrome; IV,
intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs; PT, prothrombin time; SCr, serum creatinine; TTP, thrombotic thrombocytopenic
purpura; TXA, tranexamic acid.

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The authors have no conflicts of interest or relevant disclo- burden of anemia. Hematol Oncol Clin North Am. 2016;30(2):
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