Curriculum · Hematology
Laboratory markers of haemolysis
What it is
Hemolytic markers are the laboratory findings that show red cells are being broken down, and one of them then says whether the hemolysis is immune or non-immune.
The markers that confirm hemolysis
- Reticulocyte count: elevated
- Lactate dehydrogenase (LDH): elevated
- Indirect bilirubin: elevated
- Haptoglobin: reduced, specially with IV hemolysis
- Blood film
The full hemolytic anemia workup puts the same list in order and adds to it: hemoglobin (decreased), reticulocyte (increased), haptoglobin (low), LDH (elevated), blood film, indirect bilirubin, then sickle test, Hb variants analysis and G6PD for the inherited causes, and the Coombs test, that is the antiglobulin test, for autoimmune hemolytic anemia.
The test that divides the causes
The direct antiglobulin test, DAT or Coomb's test, is the one that divides the causes: DAT positive means immune hemolysis, DAT negative means non-immune hemolysis. That is the reason the DAT is done, to know whether this is immune mediated or not.