Anaemia from premature red-cell destruction (intra- or extravascular).
Etiology
- • Inherited: G6PD, hereditary spherocytosis, sickle, thalassaemia
- • Acquired: AIHA, drug-induced, MAHA, malaria, PNH
History taking
- • Jaundice, dark urine, gallstones
- • Family history, drugs, infection, transfusion
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Reticulocytes ↑, LDH ↑, haptoglobin ↓, unconjugated bilirubin ↑
- • Blood film, DAT (Coombs)
- • G6PD assay, Hb electrophoresis as indicated
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Identify and treat cause
- • Folic acid 5 mg OD
- • Steroids for warm AIHA
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Haptoglobin near 0 + raised LDH + raised retic = strong intravascular haemolysis
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
