Differential Diagnosis for Mild Hemolysis in a Patient with Urosepsis
The following differential diagnosis is organized into categories to help guide the thought process:
- Single Most Likely Diagnosis
- Hemolysis due to sepsis-induced disseminated intravascular coagulation (DIC): This is a common complication of severe infections like urosepsis, where the coagulation cascade is activated, leading to both clotting and bleeding, including hemolysis.
- Other Likely Diagnoses
- Microangiopathic hemolytic anemia (MAHA) due to sepsis: Sepsis can cause endothelial damage, leading to MAHA, characterized by schistocyte formation and hemolysis.
- Hemolysis due to antibiotic-induced hemolytic anemia: Certain antibiotics, especially those used to treat urosepsis, can induce hemolytic anemia, especially in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
- Do Not Miss Diagnoses
- Thrombotic thrombocytopenic purpura (TTP): Although rare, TTP is a life-threatening condition that can present with hemolysis, thrombocytopenia, and renal failure, and can be triggered by severe infections like urosepsis.
- Hemolytic uremic syndrome (HUS): Similar to TTP, HUS is a condition characterized by hemolysis, thrombocytopenia, and renal failure, often associated with Shiga toxin-producing E. coli infections, which can be a cause of urosepsis.
- Rare Diagnoses
- Paroxysmal nocturnal hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for blood clot formation.
- Atypical hemolytic uremic syndrome (aHUS): A rare, life-threatening disorder that occurs when an individual has a genetic predisposition to develop the condition, often triggered by an infection or other factor, leading to uncontrolled complement activation and hemolysis.