Is This a Hemolytic Transfusion Reaction?

Christopher M. Lough, MD; Leonard I. Boral, MD, MBA; Julie Ribes, MD


December 11, 2013

In This Article

What Is the Most Likely Cause of This Patient's Hemolysis?

The hemolytic process in this patient was not immune-mediated. With this possibility ruled out, the differential diagnosis for a DAT-negative hemolysis can be divided into the following categories (Figure 3):


Acquired and hereditary defects of red cell membrane, hemoglobin, or enzymes;

Thrombotic microangiopathic hemolytic anemia (T-MAHA);

DAT-negative autoimmune hemolytic anemia due to IgA; and


Figure 3.

Differential diagnosis for causes of intravascular hemolysis resulting in a negative DAT. AIHA = autoimmune hemolytic anemia; DAT = direct antiglobulin test; DIC = disseminated intravascular coagulation; Hgb = hemoglobin; HTN = hypertension; HUS = hemolytic uremic syndrome; PNH = paroxysmal nocturnal hemoglobinuria; T-MAHA = thrombotic microangiopathic hemolytic anemia; TTP = thrombotic thrombocytopenic purpura.


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