Non-immune hemolytic anaemias
1. Big picture
Non-immune hemolytic anaemias are anaemias caused by premature red blood cell destruction without antibody-mediated destruction.
The exam pattern is:
anaemia + jaundice + dark urine ± splenomegaly + reticulocytosis + ↑ indirect bilirubin + ↑ lactate dehydrogenase + ↓ haptoglobin + negative direct Coombs test → think non-immune hemolysis.
The first clinical question is not “which drug?”, but:
Is this intravascular hemolysis, extravascular hemolysis, or a life-threatening microangiopathic hemolytic anemia?
Non-immune hemolysis includes hereditary red cell defects, mechanical destruction, microangiopathic hemolysis, infections, toxins, burns, and acquired clonal disorders such as paroxysmal nocturnal hemoglobinuria.
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