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Table 8. Hematologic Toxicities
8.1 Hemolytic Anemia
Workup/Evaluation
• History and physical examination (with special consideration of history of new drugs,
insect, spider, or snake bites)
• Blood chemistry, CBC with evidence of anemia, macrocytosis, evidence of
hemolysis on peripheral smear. LDH, haptoglobin, bilirubin, reticulocyte count, free
hemoglobin
• DIC panel which could include prothrombin time (PT)/international normalized
ratio (INR)/partial thromboplastin time (PTT), infectious causes
• Autoimmune serolog y
• Paroxysmal nocturnal hemoglobinuria (PNH) screening
• Direct and indirect bilirubin, direct agglutinin test, and if no obvious cause, bone
marrow analysis, cytogenetic analysis to evaluate MDS
• Evaluation for viral/bacterial (mycoplasma etc.) causes of hemolysis studies
• Protein electrophoresis, cryoglobulin analysis
• Workup for BM failure syndrome if refractory including B12, folate, copper,
parvovirus, iron, thyroid, infection
• Glucose-6-phosphate dehydrogenase level
• Evaluation of common drug causes (ribavirin, rifampin, dapsone, interferon,
cephalosporins, penicillins, NSAIDS, Quinine/quinidine, fludarabine, ciprofloxacin,
lorazepam, diclofenac, etc.)
• Assessment of methemaglobinemia
Grading Management
G1: Hemoglobin (Hgb)
