Hemolysis question

[Student3322]

I see LDH/haptoglobin ordered a lot in ICUs and was wondering how much of this is truly necessary. Does normal bilirubin pretty much rule out significant hemolysis or is there additional utility in ordering LDH/haptoglobin?

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[whoknows2012]

I see LDH/haptoglobin ordered a lot in ICUs and was wondering how much of this is truly necessary. Does normal bilirubin pretty much rule out significant hemolysis or is there additional utility in ordering LDH/haptoglobin?

In absence of liver disease haptoglobin can be quite useful as it is a very specific marker. LDH don’t even get me started. Sure can be followed in known hemolysis but as a screen is fairly poor in a hospitalized icu patient. In an otherwise healthy patient with isolated anemia, different story

 

[gutonc]

I see LDH/haptoglobin ordered a lot in ICUs and was wondering how much of this is truly necessary. Does normal bilirubin pretty much rule out significant hemolysis or is there additional utility in ordering LDH/haptoglobin?

No, a normal bili doesn't rule out hemolysis. You can get low-level hemolysis that is clinically significant with a normal bili. I get all the things (DAT/Coombs, LDH, hapto and direct bili) if I'm thinking about hemolysis.

 

[gutonc]

In absence of liver disease haptoglobin can be quite useful as it is a very specific marker. LDH don’t even get me started. Sure can be followed in known hemolysis but as a screen is fairly poor in a hospitalized icu patient. In an otherwise healthy patient with isolated anemia, different story

And this is why I check "all the things". No single lab will rule it it in or out. You need to use lab data in the appropriate clinical setting. If I have all the data, and the clinical scenario in place, I can figure out WTF is going on....

...and then just give them 1 mg/kg prednisone anyway because they're sick AF and it probably won't hurt...unless it will.

 

[HemeOncHopeful19]

In absence of liver disease haptoglobin can be quite useful as it is a very specific marker. LDH don’t even get me started. Sure can be followed in known hemolysis but as a screen is fairly poor in a hospitalized icu patient. In an otherwise healthy patient with isolated anemia, different story

…you guys are getting ICU consults without liver failure?