How to approach haemolysis: Haemolytic anaemia for the general physician

A Rare Case of Severe Haemolytic Anaemia Due to Folic Acid Deficiency in a Patient with Beta Thalassaemia Trait

Severe haemolytic anaemia is a rare and often overlooked presentation of folic acid deficiency. Here we describe a case of severe haemolytic anaemia secondary to folic acid deficiency in a patient with beta thalassaemia trait. A 20-year-old young woman of Pakistani origin, previously independent and active with no significant past medical history, presented with vertigo, dizziness, tiredness, and muscle stiffness. On admission, she had a haemoglobin level of 23 grams/L, folic acid level <1.3 micrograms/L with evidence of haemolysis. Her peripheral blood film was consistent with severe haematinic deficiency. Following diagnosis of severe normocytic anaemia and non-immune extravascular haemolysis secondary to folate deficiency, she received blood transfusions and high-dose oral folic acid for three months. On follow-up, haemoglobin level had improved to 104 grams/L, folate levels were replenished, and she had resumed her normal life. She was incidentally found to have beta thalassaemia trait which explained the persistent mild anaemia. Hence, folic acid deficiency when significant may lead to severe haemolytic anaemia but shows excellent haematological response to treatment with high dose oral folic acid.

[Clinical practice guidelines for the diagnosis and treatment of anemia of prematurity (2025)]

Anemia of prematurity (AOP) is a multifactorial condition associated with congenital iron deficiency, low erythropoietin levels, a short lifespan of red blood cells, and iatrogenic blood loss. AOP is a common complication in premature infants that can adversely affect growth, development, and long-term neurocognitive outcomes. To standardize the diagnosis and treatment of AOP, the Neonatal Clinical Practice Guidelines Expert Committee and the Neonatal Evidence-Based Medicine Group of the Commission of Neonatal Medicine of the Cross-Strait Medical and Health Exchange Association, along with the Editorial Office of the Chinese Journal of Contemporary Pediatrics, have developed the "Clinical practice guidelines for the diagnosis and treatment of anemia of prematurity (2025)", based on the World Health Organization's handbook for guideline development and the formulation/revision principles of Chinese clinical practice guidelines. This guideline addresses eight clinical issues related to AOP, including risk factors, early identification, etiological diagnosis, diagnostic criteria, early prevention, transfusion therapy, strategies to improve prognosis, and post-discharge follow-up. It presents 29 recommendations formed from current evidence and expert consensus, aiming to provide guidance and decision-making support for healthcare professionals in the diagnosis and treatment of AOP.

Falsely low glycosylated haemoglobin levels probably secondary to hypersplenism in a patient with diabetes mellitus

A man in his 70s presented with a history of low glycated haemoglobin (HbA1c) values despite a diagnosis of type 2 diabetes. His blood glucose readings ranged between 8 and 15 mmol/L, but his HbA1c values were below 27 mmol/mol. Initial investigations demonstrated evidence of reduced red blood cell lifespan as a cause of misleadingly low HbA1c values. Further investigation revealed chronic liver disease and splenomegaly, with hypersplenism being the probable cause of increased red blood cell turnover. HbA1c estimation was no longer reliable, so ongoing diabetic care was guided by home capillary blood glucose monitoring. Healthcare providers and clinical laboratorians need to be aware of the possible clinical implications of very low HbA1c values in patients with type 2 diabetes.