Laboratory diagnosis of haemolysis

• 4 unconjugated bilirubin with anaemia is hallmark of haemolytic anaemia.

• 4 reticulocytes (haptoglobins are unreliable in the newborn).

• Blood film—may show RBC abnormalities e.g. spherocytes, ellipto-cytes, fragmented cells.

• DAT, if +ve indicates immune haemolysis; -ve does not rule this out— especially consider ABO HDN.

• Heinz body test—positive in drug-induced haemolysis, G6PD deficiency and occasionally other enzyme disorders.

• Intravascular haemolysis—look for haemoglobinuria/haemoglobinaemia.

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