Differential Diagnosis for Hemolytic Anemia
- Single Most Likely Diagnosis
- Immune-mediated hemolysis due to Rh-mismatch: The patient received a B-negative transfusion despite being Rh-positive and B-positive. This mismatch can lead to an immune response against the transfused red blood cells, resulting in hemolytic anemia.
- Other Likely Diagnoses
- Immune-mediated hemolysis due to multi-parity: The patient has a history of two children, which increases the risk of developing alloantibodies against red blood cell antigens. However, this is less likely given the recent transfusion of mismatched blood.
- Mechanical hemolysis due to bovine prosthetic aortic valve: Although the patient has a bovine prosthetic valve, mechanical hemolysis is less common and typically associated with other signs such as thrombocytopenia and schistocyte formation.
- Do Not Miss Diagnoses
- Hemolysis due to transfusion-related acute lung injury (TRALI): Although less likely, TRALI is a potentially life-threatening condition that can occur due to transfusion of blood products. It is essential to consider this diagnosis, especially given the patient's recent transfusion.
- Hemolysis due to transfusion-associated circulatory overload (TACO): Similar to TRALI, TACO is a serious condition that can occur due to transfusion and should not be missed.
- Rare Diagnoses
- Immune-mediated hemolysis due to bovine prosthetic aortic valve: This is an extremely rare condition, and there is limited evidence to suggest that bovine prosthetic valves can cause immune-mediated hemolysis.
- Paravalvular leak with mechanical hemolysis: Although the patient has a systolic murmur, there is no clear indication of a paravalvular leak, making this diagnosis less likely. However, it is essential to consider this possibility, especially if the patient's condition worsens or if there are signs of valve dysfunction.