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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hemolytic Anemia


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
282.3 - Hemolytic Anemias Due to Enzyme Deficiency, Other; Hemolytic Nonspherocytic (Hereditary), Type II, Hexokinase Deficiency, Pyruvate Kinase [PK] Deficiency, Triosephosphate Isomerase Deficiency
282.8 - Hemolytic Anemia, Hereditary, Other Specified; Stomatocytosis
283.0 - Hemolytic Anemias, Autoimmune
283.10 - Non-autoimmune Hemolytic Anemia, Unspecified
283.19 - Non-autoimmune Hemolytic Anemias, Other; Mechanical; Microangiopathic Toxic
283.9 - Hemolytic Anemia, Acquired, Unspecified; Acquired Hemolytic Anemia NOS; Chronic Idiopathic Hemolytic Anemia

Related Terms

  • Acquired Hemolytic Anemia
  • Autoimmune Hemolytic Anemia
  • Drug-induced Hemolytic Anemia
  • Idiopathic Anemia
  • Inherited Hemolytic Anemia
  • Nonimmune Hemolytic Anemia

Overview

Hemolytic anemia is a general term applied to conditions in which red blood cells have a shortened life span. For a variety of reasons, the red blood cells are broken down or removed from circulation faster than they can be produced. Anemia is due to an abnormally low number of red blood cells in circulation.

Hemolytic anemia may result from disorders that are either inherited or acquired. The anemia-producing inherited disorders are generally responsible for abnormalities within the red blood cell. These genetically determined defects include defects of the membrane (as in hereditary spherocytosis), defects in the structure or production of hemoglobin (as in sickle cell anemia or thalassemia), or deficiencies of needed enzymes (as in pyruvate kinase deficiency).

Many of the acquired disorders that cause hemolytic anemia involve the immune system. In autoimmune hemolytic anemia, red blood cells are destroyed by antibodies produced by the individual's own immune system. In a transfusion reaction, antibodies destroy red blood cells as a result of mismatched blood. Acquired disorders that do not involve the immune system include conditions that cause the red blood cells to break into fragments (as in some coagulation disorders or complications of mechanical heart valves); intracellular infections, such as malaria; exposure to toxic chemicals; adverse drug reactions; excessive trapping of blood cells in the spleen (hypersplenism); or other acquired diseases, such as a bone marrow disorder that predisposes blood cells to early destruction (paroxysmal nocturnal hemoglobinuria).

Incidence and Prevalence: Approximately 4 of 100,000 individuals have hemolytic anemia. A little less than half of these (1 to 2 of 100,000) have autoimmune hemolytic anemia.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for developing hemolytic anemia vary according to the cause of the anemia. For example, anemia associated with sickle cell disorders develop primarily in blacks, some Arabics and Aborigines in southern India (Schick). The risk of developing many of the inherited disorders depends on whether or not the disorder, or the gene for the disorder, is already present in the family. In contrast, the risk of autoimmune hemolytic anemia does not vary with racial groups, nor does it seem to be influenced by genetic factors. However, females are more commonly afflicted with autoimmune hemolytic anemia. Alternatively, males are usually affected by anemia associated with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (Schick).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms will vary depending on how quickly the hemolytic anemia develops and progresses. An individual with slow development may report only some yellowing of the skin and eyes (jaundice). Individuals with a more rapid onset of anemia may have fatigue and shortness of breath. With an acute onset, there may be fever, chills, headache, and pain in the back, abdomen, or extremities. Individuals may report urine that is red or dark. Individuals with hemolytic anemia typically do not have abnormal bleeding.

Physical exam: Findings may include paleness of the skin (pallor), rapid heart rate, and rapid breathing. Mild yellowing of the skin and eyes due to the presence of bile pigment in the blood (jaundice) is usually present. The spleen and liver may be enlarged. Signs of heart failure can be seen with severe anemia.

Tests: A complete blood count (CBC) shows an abnormally low number of red blood cells and a low hemoglobin level. These findings correlate with the degree of anemia. A count of immature red blood cells (reticulocyte count) shows an increased number. A peripheral blood smear may show abnormally shaped red blood cells and cell fragments.

Serum bilirubin will be elevated. The direct Coombs test will be positive in immune hemolytic anemias. Other tests specific to the suspected cause of the hemolytic anemia will vary.

Source: Medical Disability Advisor



Treatment

Medical treatment is given that is specific for the disorder that is causing the anemia. In general, surgical removal of the spleen (splenectomy) and oral folic acid supplements may be recommended.

Some cases of immune hemolytic anemias are mild enough that no treatment is required. Significant anemia may be treated with steroids or other immunosuppressive drugs. A minority of individuals may need a blood transfusion to replace destroyed red blood cells. Life-threatening immune hemolytic anemia may be treated with plasmapheresis, a procedure in which an individual's plasma is removed, processed, and then replaced.

Source: Medical Disability Advisor



Prognosis

Outcome varies widely among the various hemolytic anemias and is dependent on the causative disorder. If no serious comorbid conditions exist (e.g., leukemia, myeloma), the prognosis of hemolytic anemia is generally good. Overall, mortality resulting from hemolytic anemia is low.

Removal of the spleen (splenectomy) effectively stops the entrapment and removal of normal red blood cells by an enlarged spleen (hypersplenism), thereby boosting the number of red blood cells in the circulation. Splenectomy, however, does not correct the original red blood cell defect or condition affecting the red blood cells. Transfusion of red blood cells temporarily increases the number in circulation. Folic acid supplements will help increase hemoglobin levels, helping to counteract the effects of the hemolytic process.

Up to 80% of individuals with immune hemolytic anemia respond to steroid treatment, and up to 50% respond to other immunosuppressive medications. The effects of the removal of plasma (plasmapheresis), which contains the destructive antibodies, are short-term, but life-saving in a hemolytic emergency.

Source: Medical Disability Advisor



Differential Diagnosis

  • Cancer (especially lymphoma)
  • Heart failure

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Hematologist
  • Internal Medicine Physician

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

The increased breakdown of red blood cells can result in bile blockage in the liver and gallstone formation. Non-healing leg ulcers can be seen. Kidney failure and even shock can result from acute, severe destruction of red blood cells (hemolysis). Severe anemia can result in heart failure.

Source: Medical Disability Advisor



Factors Influencing Duration

Severity of the anemia, availability of treatment, and response to treatment will influence the length of disability. For example, those with underlying cardiovascular conditions or advanced age are more likely to have severe, debilitating symptoms associated with the anemia, such as shortness of breath and rapid heart rate.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A persistent anemia may require reduction in the physical requirements of work. This reduction may be temporary or permanent depending on the availability of and response to treatment. If splenectomy is performed, time off for recovery will be needed.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of hemolytic anemia been confirmed?
  • Was specific disorder causing the hemolytic anemia identified?
  • Has individual experienced any complications from the hemolytic anemia?
  • Does individual have an underlying condition that may impact recovery such as cardiovascular disease, liver disease, or malignancy?

Regarding treatment:

  • Is underlying condition responding to treatment?
  • If not, what other treatment options are available?
  • If condition is caused by reaction to a drug, has individual stopped taking that drug?
  • Was another medication successfully substituted?
  • Would individual benefit from supplemental oral folate?
  • Has individual taken steroids or immunosuppressive drugs as prescribed? If not, what can be done to increase compliance?
  • Was splenectomy, blood transfusion or plasmapheresis required? With what results?

Regarding prognosis:

  • What is the current prognosis for the underlying condition?
  • Would individual benefit from steroid or immunosuppressive therapy?
  • Since many therapies help only on a short-term basis, what is the long-term treatment plan?
  • Is individual's red blood cell count monitored on a regular basis?

Source: Medical Disability Advisor



References

Cited

Schick, Paul. "Hemolytic Anemia." eMedicine. Eds. Rodger L. Bick, et al. 29 Sep. 2004. Medscape. 13 Oct. 2004 <http://emedicine.com/med/topic979.htm>.

Source: Medical Disability Advisor