🩸 Hemolysis · Anemia · Jaundice · Splenomegaly · G6PD · Sickle Cell · Spherocytosis

Schwartz Clinical Handbook — Chapter 40 · Hereditary spherocytosis · G6PD deficiency · Sickle cell disease · Autoimmune hemolytic anemia · Transfusion reaction · Microangiopathic

Select anemia onset, jaundice, splenomegaly, dark urine, family history, ethnicity, and trigger (drug/infection) → differentiate hereditary spherocytosis, G6PD deficiency, sickle cell disease, autoimmune hemolytic anemia, microangiopathic (HUS/TTP), and transfusion reaction.
⚠️ Red flags: severe anemia, hypotension, renal failure, DIC → urgent transfusion, hematology consult.

📋 Step 1 — Hemolysis pattern & lab clues
📌 Diagnostic impressions
📖 Schwartz Ch 40

Select anemia onset (acute vs chronic), jaundice, dark urine, splenomegaly, family history, ethnicity, precipitant (drug, fava beans, infection), and Coombs test → differential includes hereditary spherocytosis, G6PD deficiency, sickle cell disease, autoimmune hemolytic anemia, HUS/TTP, and transfusion reaction.

✔️ Spherocytosis: family history, splenomegaly, positive osmotic fragility.
✔️ G6PD: acute hemolysis after oxidant stress (fava, sulfa), bite cells.
✔️ Sickle cell: HbSS, HbSC, vaso‑occlusive pain, acute chest.
✔️ AIHA: positive DAT, warm vs cold, steroids.
📘 Schwartz pearls (Chapter 40)
• Reticulocytosis + indirect hyperbilirubinemia + low haptoglobin = hemolysis.
• G6PD testing: delay until after acute hemolysis (false normal).
• Sickle cell: newborn screening, penicillin prophylaxis, hydroxyurea.
• Splenectomy for hereditary spherocytosis if severe anemia.
• Autoimmune hemolytic anemia: IVIG, steroids, rituximab.