Key messages

• The diagnosis of hemolytic anemia in the critical care setting can be challenging due to the multifactorial nature of patients' pathophysiology and multiple therapies which may be complicated by hemolytic anemia.

• A problem-oriented approach to the cause of hemolysis centers around examination of the blood film, which requires close liaison with the hematology laboratory.

• In the critical care setting the hemolysis may have an acute onset and the marrow may be slow in responding due to suppression from shock or sepsis. Introduction

The diagnosis and investigation of hemolytic anemia in the critical care medicine setting can be challenging because of the multifactorial nature of the patient's pathophysiology, confounding factors, and multiple therapies which may be complicated by hemolytic anemia. As hemolysis is an important diagnosis to establish and may present in a plethora of clinical settings and in many deceptive ways, it is important to have a good problem-solving approach to the initial assessment and definitive diagnosis of hemolysis. In the critical care setting hemolysis is usually of acute onset as a feature of the primary disease or a complication of therapy.

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