Clinical Heterogeneity and Diagnostic Challenges in Newly Diagnosed Hemolytic Anemia: A Case Series From South India

Hemolytic anemia encompasses a wide spectrum of etiologies and clinical manifestations, often creating diagnostic complexity in acute care settings. Adult case-based data from low- and middle-income countries remain limited. This descriptive case series included 10 consecutive patients with newly diagnosed hemolytic anemia admitted to a tertiary care teaching hospital in South India between January 2020 and July 2021. Clinical presentation, laboratory findings, etiological diagnoses, treatment interventions, and short-term outcomes were analyzed, with follow-up for 90 days after discharge. The median age at diagnosis was 38.5 years, with female predominance. Autoimmune hemolytic anemia was the most frequent etiology, followed by vitamin B12 deficiency-associated hemolysis and thrombotic microangiopathy. Clinical presentation was heterogeneous, and classical bedside findings such as overt icterus and clinically detectable splenomegaly were absent in several patients despite biochemical or radiological evidence of disease. Median hemoglobin at presentation was 3.4 g/dL, reflecting severe disease burden. All patients were discharged in stable condition, with one recurrence documented during follow-up. Newly diagnosed hemolytic anemia in adults demonstrates marked etiological and clinical heterogeneity. Overlapping nutritional and immune-mediated mechanisms should be considered during evaluation, and a broad diagnostic framework is essential for timely recognition and management.