Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- palidez
- ictericia
Other diagnostic factors
- fatiga
- disnea
- mareos
- esplenomegalia
- infecciones activas
- orina oscura episódica (hemoglobinuria)
- provocada por exposición al frío
Risk factors
- trastornos autoinmunitarios
- trastornos linfoproliferativos
- válvula cardíaca protésica
- cuya familia originalmente proviene del Mediterráneo, Oriente Medio, África o el sudeste asiático
- antecedentes familiares de hemoglobinopatía o defectos de la membrana de los eritrocitos
- hemoglobinuria paroxística nocturna
- exposición reciente a cefalosporinas, penicilinas, derivados de la quinina o antiinflamatorios no esteroideos
- exposición reciente a naftaleno o a habas
- lesión térmica
- esfuerzo fuera de lo común
- exposición reciente a nitritos, dapsona, ribavirina o fenazopiridina
- ingesta reciente de paraquat
- malaria
- babesiosis
- bartonelosis
- leishmaniasis
- infección por Clostridium perfringens
- infección por Haemophilus influenzae tipo B
- hepatopatía
Diagnostic tests
1st tests to order
- hemograma completo (HC)
- concentración de hemoglobina corpuscular media (CHCM)
- recuento de reticulocitos
- frotis de sangre periférica
- bilirrubina no conjugada (indirecta)
- lactato deshidrogenasa (LDH)
- haptoglobina
- análisis de orina
Tests to consider
- prueba de antiglobulina directa (Coombs)
- creatinina, urea
- pruebas de función hepática (PFH)
- anticuerpos de Donath-Landsteiner
- electroforesis de hemoglobina (Hb)
- citometría de flujo para CD55/CD59
- prueba de mancha fluorescente y espectrofotometría de glucosa-6-fosfato deshidrogenasa (G6PD)
- anticuerpo antinuclear
Treatment algorithm
adquirida: prueba de antiglobulina directa (test de Coombs) positiva
adquirida: prueba de antiglobulina directa (test de Coombs) negativa
trastornos hereditarios
Contributors
Authors
John Densmore, MD, PhD
Associate Professor of Clinical Medicine
Department of Medicine
University of Virginia
Charlottesville
VA
Disclosures
JD declares that he has no competing interests.
Acknowledgements
Dr John Densmore would like to gratefully acknowledge Dr Michelle Loch, a previous contributor to this monograph. ML declares that she has no competing interests.
Peer reviewers
Pasquale Niscola, MD
Hematology Unit
Sant'Eugenio Hospital
Rome
Italy
Disclosures
PN declares that he has no competing interests.
Alan Lichtin, MD
Staff Hematologist-Oncologist
Hematologic Oncology and Blood Disorders
Cleveland Clinic
Associate Professor
Internal Medicine
Cleveland Clinic Lerner College of Medicine
Cleveland
OH
Disclosures
AL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood. 2017 Jun 1;129(22):2971-9 Abstract
Hill QA, Stamps R, Massey E, et al. The diagnosis and management of primary autoimmune haemolytic anaemia. Br J Haematol. 2017 Feb;176(3):395-411.Full text Abstract
Hill QA, Stamps R, Massey E, et al. Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia. Br J Haematol. 2017 Apr;177(2):208-20.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Anemia causada por pérdida de sangre
- Anemia por subproducción
- Reacción a la transfusión
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