A 70 year old female presents unwell with compensated shock, pallor and shortness of breath
- Differential diagnosis:
Haemolytic anaemia
Infection – pneumonia, other
Cardiac failure – high output due to severe anaemia
Haemorrhage – upper GI bleed
2. Low Hb, high LDH, high Reticulocytes – severe anaemia with normal bone marrow function
high WCC, high neutrophil – Infection
High Urea, low Hb – Upper GI haemorrhage
3. Haptoglobin – low in haemolytic anaemia
Direct Coombs test – positive in autoimmune haemolytic anaemia (detects antibodies bound to red blood cells) (Indirect coombs test detects antibodies found in plasma – eg. Rhesus, blood group incompatibility)