Therefore, the Ham test, which measures the degree of hemolysis in acidified serum, is very reliable and has great diagnostic accuracy. The sucrose hemolysis test is also based on susceptibility of red cells to complement action, but it can be positive in patients with other disorders, such as agnogenic myeloid metaplasia. It is believed that infusion of blood products containing complement may enhance hemolysis. Washed erythrocytes are not necessary. Alternatively, prednisone therapy at a level of 20 to 60 mg every other day may reduce transfusion requirements without producing severe cushingoid symptoms.
Splenectomy is of very questionable benefit.
Surgery is a problem in patients with PNH because stasis and trauma accentuate hemolysis and venous occlusion. If surgery is to be performed, prophylactic anticoagulation with warfarin or one of its derivatives in the immediate postoperative period should be considered. Patients with PNH are frequently iron deficient. The simple administration of iron to correct this defect, however, often aggravates hemolysis because iron therapy produces a cohort of new cells, many of which are susceptible to complement-mediated lysis. Prior transfusion may help circumvent this problem.