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Anemia hemolítica

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 17 Aug 2025
Última atualização: 19 Dec 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo
  • palidez
  • ictericia
Detalhes completos

Outros fatores diagnósticos

  • fatiga
  • disnea
  • mareos
  • esplenomegalia
  • infecciones activas
  • orina oscura episódica (hemoglobinuria)
  • provocada por exposición al frío
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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
Detalhes completos

Investigações a serem consideradas

  • 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
Detalhes completos

Algoritmo de tratamento

AGUDA

adquirida: prueba de antiglobulina directa (test de Coombs) positiva

adquirida: prueba de antiglobulina directa (test de Coombs) negativa

trastornos hereditarios

Colaboradores

Autores

John Densmore, MD, PhD

Associate Professor of Clinical Medicine

Department of Medicine

University of Virginia

Charlottesville

VA

Declarações

JD declares that he has no competing interests.

Agradecimentos

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.

Revisores

Pasquale Niscola, MD

Hematology Unit

Sant'Eugenio Hospital

Rome

Italy

Declarações

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

Раскрытие информации

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.

Список литературы

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Основные статьи

Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood. 2017 Jun 1;129(22):2971-9 Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

Статьи, указанные как источники

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