DAT: direct antiglobulin test (direct Coombs test); G6PD: glucose-6-phosphate dehydrogenase; PK: pyruvate kinase; PNH: paroxysmal nocturnal hemoglobinuria; RBC: red blood cell; CBC: complete blood count; AIHA: autoimmune hemolytic anemia; LDH: lactate dehydrogenase.
* DAT-negative hemolysis is characterized by:The rest of the CBC is typically normal. If there is new onset hemolytic anemia and/or other cytopenias, the differential diagnosis expands to include disorders such as paroxysmal nocturnal hemoglobinuria (PNH).
¶ Up to 5 to 10% of AIHA is DAT-negative and requires more specialized testing. Refer to UpToDate for discussions of rare RBC enzyme disorders.
Δ Other testing approaches may be reasonable, such as:If initial testing is negative, evaluate for other disorders with the help of an expert in RBC enzyme disorders.
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