• Bone marrow transplantation–associated microangiopathy FIGURE 93.2 Approach to evaluation of hemolytic anemia Examination of the peripheral blood smear is helpful in diagnosing subsets of nonimmune hemolytic anemia especially in the acute care setting when the results of disease-specific testing such as osmotic fragility, hemoglobin electrophoresis, or G6PD activity will not be available Certain patterns of red cell morphology can support a diagnosis of hemoglobinopathy or enzymopathy The presence of RBC fragments (schistocytes) on the peripheral smear suggests mechanical damage to the erythrocyte If the diagnosis is uncertain, a pretransfusion blood sample should be saved for additional testing such as the measurement of specific enzyme levels or hemoglobin electrophoresis The diagnosis of microangiopathic processes such as hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) is important and should be considered in patients with diarrhea, and in the presence of acute kidney injury, thrombocytopenia, fever, and neurologic changes Disseminated intravascular coagulopathy (DIC) occurs in the context of systemic illness, including sepsis, trauma, or malignancy If considering any microangiopathic process, evaluation should also include a coagulation panel Management AIHA Prompt initiation of therapy for AIHA is necessary to stabilize the rate of hemolysis Hospitalization for careful observation and treatment is usually necessary;