摘要
內科病人常見的貧血中，有一部分是屬於相對少見的溶血性貧血（hemolytic anemia, HA）。在成年人的後天性溶血中，可以大致分為免疫相關（immune-mediated）及非免疫相關（non-immune mediated），這兩大類下面又各自有許多不同的鑑別診斷。由於不常見，其診斷有賴臨床醫師的警覺性。而使用一套有系統的評估方式，能夠讓我們更迅速且確實地評估一位溶血性貧血的病人。尤其雖然罕見，但有一些溶血性疾病的臨床病程進展快速，未能及時給予正確的治療可能導致死亡。因此，要藉由各種相關的實驗室檢驗，鑑別可能造成溶血的原因，並且找出背後導致溶血的疾病，才能給予病人適當的處置。本篇綜論除了介紹各種不同的溶血性貧血外，也希望能針對這些病人，提供在臨床實務上如何進行評估與處置的一些方法。
並列摘要
Anemia is a common condition in adult patients in the internal medicine department, presenting with various etiology and clinical manifestation. Among them, hemolytic anemia (HA) is a rather rare condition, which also comprises a lot of different diseases. We may categorize the HA according to whether it’s congenital or acquired, intracorpuscular or extracorpuscular, acute or chronic, immune-mediated or not, etc. One must first collect detailed clinical information, including history and laboratory evidence, to establish the clinical impression of hemolytic anemia. Subsequently, direct antiglobulin test (DAT) and peripheral blood smear (PB smear) should be evaluated. With all these information, we may be able to better differentiate the cause of the hemolysis. Of note, aggressively searching for an underlying cause of a secondary hemolysis is equally important in terms of evaluation for hemolytic anemia. This review article aims to introduce the different etiology and mechanisms of hemolytic anemias, and more importantly, to provide a practical guide on how to approach those suspected to have hemolytic anemia.