Diagnosis of hemolytic anemia:

Hemolytic anemia is diagnosed based on clinical findings (the symptoms of hemolytic anemia such as pale skin, breathlessness, generalized weakness etc.) and certain laboratory investigations. The first test (laboratory test) done for diagnosis of anemia (including hemolytic anemia) is hemoglobin estimation. According to World Health Organization (WHO) hemoglobin level below 130 grams per liter blood in adult male is anemia and hemoglobin level below 120 grams per liter blood in adult female is anemia. Once anemia is diagnosed the next step is to find out type of anemia (such as hemolytic anemia, iron deficiency anemia, pernicious anemia etc.). The laboratory tests done for diagnosis of hemolytic anemia include peripheral blood smear microscopy, estimation of bilirubin (mainly unconjugated bilirubin), Coombs test, estimation of lactate dehydrogenase, hemosiderin and urobilinogen estimation etc.

Peripheral blood smears microscopy:

This is an important investigation in diagnosis of hemolytic anemia. The red blood cell morphology may show abnormality such as the red blood cells become smaller and rounder (spherocytes). There may be fragments of red cells in the peripheral blood smear. The reticulocytes (the precursors of red blood cells) may be higher in number.

Bilirubin level will be elevated (normally 0.1 to 0.8 mg per 100 ml blood), which may cause jaundice. Coombs test (direct Coombs test), if positive indicates hemolysis (breakdown of red cells) due to immune response. Increased hemosiderin level in urine indicates intravascular hemolysis.

Treatment of Hemolytic anemia:

The definitive treatment of hemolytic anemia depends on the cause of the anemia. Symptomatic treatment of hemolytic anemia (as well as all other types of anemia) includes blood transfusion (packed red cell transfusion or whole blood transfusion), especially if anemia is marked.

If extravsacular hemolysis is predominant, removal of spleen (splenectomy) may cause improvement of hemolytic anemia, as most red cells are red cells are removed from circulation by spleen. If hemolytic anemia is due to immune related cause treatment with steroids may be helpful.

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