Knowledge Check

Which of the following are serum markers of hemolysis?

Haptoglobin

ALT

Urine hemosiderin

No, the question was about serum markers 🙂

LDH

Direct bilirubin

No, hemolysis is associated with elevated indirect bilirubin.

Which of the following hemolytic markers are derived directly from red cells?

Bilirubin

Haptoglobin

Free hemoglobin

LDH

AST

True or false: a negative Coombs test (direct antiglobulin test) virtually rules out immune-mediated hemolysis.

True

The Combs test may be negative in exceptional cases of immune-mediated hemolytic anemia.

False

A negative Coombs test almost always indicates that hemolysis is caused by non-immune mechanisms. These can be divided into extracorpuscular causes and intracorpuscular causes.

Is valve hemolysis an example of intra- or extracorpuscular hemolysis?

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Extracorpuscular

What are some other causes of non-immune extracorpuscular hemolysis?

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TMA
Burns
Infection
Cirrhosis
Copper excess

What conditions are classically associated with schistocytes on the peripheral smear?

Warm autoimmune hemolytic anemia

Thrombotic microangiopathy (e.g., TPP)

Pyruvate kinase deficiency

Microangiopathic hemolytic anemia

Spur cell anemia

What are treatment options for a patient with valve hemolysis?

Propranol

Pentoxifylline

Folate

Transcatheter repair

Open surgical repair

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