Hemolytic anemia is defined as anemia due to a shortened survival of circulating red blood cells (RBCs) due to their premature destruction.

There are numerous causes of hemolytic anemia, including inherited and acquired conditions, acute and chronic processes, and mild to potentially life-threatening severity.










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You are asked to review the peripheral blood smear from a patient with anemia. Serum lactate dehydrogenase and total bilirubin are elevated, and there is hemoglobinuria. Which physical examination finding this patient is likely to have?


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From RS Hillman et al: Hematology in Clinical Practice, 5th ed. New York, McGraw-Hill, 2010.


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The correct answer is C. You answered C.

The answer is C. This blood smear shows fragmented RBCs of varying size and shape. In the presence of a foreign body within the circulation (prosthetic heart valve, vascular graft), RBCs can become destroyed. Such intravascular hemolysis will also cause serum lactate dehydrogenase to be elevated and hemoglobinuria. In isolated extravascular hemolysis, there is no hemoglobin or hemosiderin released into the urine. The characteristic peripheral blood smear in splenomegaly is the presence of Howell-Jolly bodies (nuclear remnants within RBCs). Certain diseases are associated with extramedullary hematopoiesis (e.g., chronic hemolytic anemias), which can be detected by an enlarged spleen, thickened calvarium, myelofibrosis, or hepatomegaly. The peripheral blood smear may show teardrop cells or nucleated RBCs. Hypothyroidism is associated with macrocytosis, which is not demonstrated here. Chronic gastrointestinal blood loss will cause microcytosis, not schistocytes.




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