Laboratory findings in hemolysis and hemolytic anemia

Finding	Change in hemolytic anemia
Anemia*	Decreased hemoglobin Decreased hematocrit
Bone marrow response/recovery	Increased reticulocyte count Underestimation of HbA1C
Release of RBC contents	Increased LDH Increased indirect bilirubin Decreased haptoglobin Hemoglobinemia in intravascular hemolysis^¶ Hemoglobinuria in intravascular hemolysis^¶
RBC morphology changes^Δ	Spherocytes or microspherocytes in immune hemolysis Schistocytes in microangiopathic hemolysis Blister or bite cells in oxidant injury Sickle cells in sickle cell disease Target cells and teardrop cells in thalassemia

Intravascular hemolysis often starts acutely and can be a medical emergency associated with DIC, AKI, and hypotension. Extravascular hemolysis can be chronic. Severe hemolysis can have intravascular and extravascular features. Values for HbA1C may be lower due to increased RBC turnover. Refer to UpToDate for details of the evaluation, interpretation of laboratory findings, use of the Coombs (antiglobulin) test, and management.

HbA1C: glycosylated (glycated) hemoglobin; RBC: red blood cell; LDH: lactate dehydrogenase; DIC: disseminated intravascular coagulation; AKI: acute kidney injury.

* The presence and severity of anemia depends on the degree of hemolysis and capacity of the bone marrow to compensate by increasing erythropoiesis.

¶ Intravascular hemolysis can be a medical emergency with free hemoglobin in the blood and associated with complications including DIC and acute renal failure. Findings associated with intravascular hemolysis may include schistocytes on the blood smear, hemoglobinemia (with red serum), hemoglobinuria (with dark or red urine), and hemosiderinuria in the urine sediment.

Δ Refer to UpToDate for additional details of these and other RBC morphologies and their implications.

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Laboratory findings in hemolysis and hemolytic anemia