Causes of hemolytic anemia in children

Intrinsic red blood cell defects

Hemoglobinopathies (eg, sickle cell disease, thalassemias)

Membrane defects (eg, hereditary spherocytosis, elliptocytosis)

Enzyme deficiencies (eg, G6PD, pyruvate kinase deficiencies)

Extrinsic hemolytic processes

Autoimmune hemolytic anemia (AIHA)

Warm-reactive
Cold agglutinin disease
Paroxysmal cold hemoglobinuria

Hypersplenism

Systemic disease

Infection (eg, malaria, Clostridium perfringens)
Liver disease
Renal disease

Drugs and toxins*

Microangiopathies

Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (congenital or acquired)
Disseminated intravascular coagulation (DIC)

Mechanical damage (eg, artificial heart valves, Kasabach-Merritt phenomena)

Wilson disease

Combined mechanism (intrinsic and extrinsic)

Paroxysmal nocturnal hemoglobinuria (PNH)

G6PD: glucose-6-phosphate dehydrogenase.
* For details of specific agents, refer to separate UpToDate content on hemolytic anemia due to drugs and toxins.

Courtesy of Michael Recht, MD, PhD.

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Causes of hemolytic anemia in children