eMedicine Specialties > Hematology > Red Blood Cells and Disorders

Hemolytic Anemia: Follow-up

Author: Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
Contributor Information and Disclosures

Updated: Apr 27, 2009

Follow-up

Further Inpatient Care

  • Monitor the hemoglobin level, reticulocyte count, indirect bilirubin, LDH, and haptoglobin in patients with hemolytic anemia to determine the response to therapy.
  • Monitor urine hemoglobin and hemosiderin to evaluate the response of intravascular hemolysis therapy.
  • Avoid transfusions unless evidence of angina, cardiopulmonary decompensation, or other severe organ impairment due to anemia is present.
  • Continue to administer folic acid.
  • Administer oral iron to patients who have become iron deficient due to intravascular hemolysis.
  • Taper corticosteroids.
  • Treat the underlying cause of the hemolysis.

Further Outpatient Care

  • Initially, monitor hemoglobin, reticulocyte count, and other parameters of hemolysis closely. After the initial period, monitor these limits as indicated.
  • Treat the underlying disorder.
  • Continue folic acid, because a patient with ongoing hemolysis consumes this vitamin for the accelerated production of erythrocytes.
  • Taper corticosteroids. However, if indicated, patients may have to continue low-dose steroids if no contraindications exist for prolonged corticosteroid therapy.

Deterrence/Prevention

  • Avoid medications that can induce immune hemolysis in susceptible individuals or oxidant medications that can cause hemolysis in patients with G6PD deficiency.

Prognosis

  • The prognosis for hemolytic anemia depends upon the underlying cause.

Patient Education

  • The patient with hemolytic anemia must be able to identify symptoms and signs of hemolysis recurrence and seek prompt medical attention if they occur.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose hemolytic anemia and treat correctly
 


More on Hemolytic Anemia

Overview: Hemolytic Anemia
Differential Diagnoses & Workup: Hemolytic Anemia
Treatment & Medication: Hemolytic Anemia
Follow-up: Hemolytic Anemia
Multimedia: Hemolytic Anemia
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Clinical Trials

National Guidelines Clearinghouse

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Keywords

hemolytic anemia, autoimmune hemolytic anemia, anemia, hemolysis, microangiopathic anemia, premature erythrocyte destruction, hereditary hemoglobin abnormalities, glucose-6-phosphate dehydrogenase deficiency, G6PD deficiency, G-6-PD deficiency, hereditary spherocytosis, sickle cell anemia, sickle cell trait, sickle cell disease, AIHA, disseminated intravascular coagulation, DIC, hemolytic uremic syndrome, HUS, hemolytic-uremic syndrome, TTP, thrombotic thrombocytopenic purpura, defective prosthetic cardiac valves, parvovirus B19 infection

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Contributor Information and Disclosures

Author

Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Rodger L Bick, MD, PhD, FACP, Clinical Professor of Medicine, University of Texas Southwestern Medical Center; Director, Dallas and Pacific Thrombosis Hemostasis and Vascular Medicine Clinical Center
Rodger L Bick, MD, PhD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Blood Banks, American Cancer Society, American College of Angiology, American College of Physicians, American Geriatrics Society, American Heart Association, American Medical Association, American Society for Clinical Pathology, American Society of Hematology, Association of Clinical Scientists, California Medical Association, California Thoracic Society, International College of Angiology, International Society of Hematology, International Society on Thrombosis and Haemostasis, New York Academy of Sciences, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Director of the Hoxworth Blood Center, Professor, Departments of Internal Medicine and Pathology, University of Cincinnati Medical Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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