Patients with hemolysis may present with acute anemia, jaundice, hematuria, dyspnea, fatigue, tachycardia, and possibly hypotension. Mechanisms include poor deformability leading to trapping and phagocytosis, antibody-mediated destruction through phagocytosis or direct complement activation, fragmentation due to microthrombi or direct mechanical trauma, oxidation, or direct cellular destruction. Hemolysis may occur intravascularly, extravascularly in the reticuloendothelial system, or both. It should be part of the differential diagnosis for any normocytic or macrocytic anemia. Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or life-threatening.
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