First Things First (assess & treat for the following)

• Characterized by premature RBC destruction greater than increased RBC production (erythrocytosis), spherocytosis without bleeding
• Most cases are caused by extrinsic factors: drugs, exogenous antibodies, mechanical trauma, infections & toxins.
• 50% of cases are idiopathic or primary and not associated with pre-existing disease.
• Autoimmune hemolytic anemia has shortened RBC lifespan with positive Coombs’ test.
  • ≥80% of cases are of warm reactive autoantibodies of IgG subclass; the rest are cold reactive.
  • Hemolysis occurs when nonphagocytized RBCs take on a spherical shape, rendering them poorly deformable and rigid.
  • These acquired spherocytes make them apt to destruction.

• Indirect hyperbilirubinemia is usually present and highly suggestive of hemolytic anemia.
• Watch for signs of organ dysfunction.
• Obtain early hematologic consult.