Extravascular hemolysis is typically manifested by which triad?

• A. Anemia, hepatomegaly, ascites
• B. Thrombocytopenia, purpura, fever
• C. Anemia, Splenomegaly, Jaundice
• D. Polycythemia, splenomegaly, pruritus

Answer: (C)

Extravascular hemolysis happens when red cells are primarily destroyed by macrophages in the spleen. This ongoing clearance reduces circulating red cells, producing anemia, and the spleen works harder to remove the old or damaged cells, leading to splenomegaly. The heme from destroyed red cells is converted to bilirubin, mainly unconjugated, which accumulates and causes jaundice. So the classic clinical trio you’d expect is anemia, splenomegaly, and jaundice.

The other findings don’t fit this pattern. Hepatomegaly with ascites points more toward liver disease or portal hypertension, not the spleen-dominant clearance seen in extravascular hemolysis. Thrombocytopenia with purpura and fever suggests a different hematologic or infectious process. Polycythemia with splenomegaly and pruritus aligns more with a myeloproliferative state like polycythemia vera, not hemolysis.