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MODERATOR-DR.AMIT VARMA
PRESENTAOR –DR.SUNIL BHATT
 Normal shape of RBC- biconcave
 Normal life span of RBC-120 day
 Hemolytic anemia is a form of anemia due to
haemolysis ,the abnormal premature breakdown of
red blood cells (RBCs)either...
Compensatory action of bone
marrow
 In response to haemolytic anaemia –dec haemoglobin
 Oxygen supply to kidney is dec,
...
evidence of haemolyis Jaundice due to unconjugated hyperbilirubinemia.
 jaundice is mild to moderate.
 lemon yellow col...
PERIPHERAL BLOOD FILM
evidence of haemolysis
 Normal reticulocyte count in blood is 1 to 2%
 In haemolysis reticulocyte ...
EXTRAVASCULAR OR
INTRAVASCULAR
extravascular
 SPLENOMEGALY
 intravascular
 dec haptoglobin or absent haptoglobin
 Hae...
FEATURES OF EXTRAVASCULAR
HAEMOLYSIS(HERIDITARY
SPHEROCYTOSIS)
PBF
 MCV –DEC
 MCH -NORMAL
 MCHC –HIGH
 RBC SHAPE –SPH...
ACUTE OR CHRONIC intravascular
haemolysis
ACUTE
Haemoglobinemia,
methaemoglobinemia,
low haptoglobin
Haemoglobinuria
CHRON...
Intrinsic and extrinsic causes
 INTRINSIC CAUSES –cause is related to RBC itself.
 EXTRINSIC CAUSES-where factors extern...
Intrinsic causes
 INHERITED
 Membrane defects
 Enzymes defect
INTRINSIC CAUSES
INHERITED
 Heriditary spherocytosis
 Heriditary elliptosytosis
ACQUIRED
 PNH
PNH
 Acquired
 Mutation of myeloid cells
 On x chromosomes on short arm
 PIG-A gene-GPI PHOSPHOLIPIDS on cell membrane...
 Haemolysis occur all the time
 During sleep occurs more
 Breathing become slow –inc in co2---produce acidic enviornmen...
Enzyme defect
 Hexokinase
 Pyruvate kinase
 G6PD Deficiency
 Glutathione synthese
Glycolysis pathway
disturbed
 Haemoglobin synthesis defect
 GLOBIN CHAIN SYNTHESIS IS QUANTITATIVELY REDUCED
 THALASEMIA(ALPHA OR BETA )
 QUALITATI...
Extrinsic causes
 Immune mediated causes like
ISO ANTIBODY---ABO ,Rh
AUTO ANTIBODY---
Warm cold agglutinins cold haemolys...
WARM ANTIBODY
 IgG
 37 DEGREE CENTIGRADE
 DIRECTED AGAINST -Rh antigen
 Monomeric cannot agglutinate
 Compliment syst...
Cold antibody
 IgM
 Agglutinate
 <37 degree centigrade
 I antigen
 Works only when peripheral parts are exposed to co...
Cold haemolysin
 <37 degree centigrade
 IgG
 P component in RBC
sticks to rbc at lower temp in extremities
 Activates ...
Non immune mediated
 Macro angiopathic haemolytic anaemia
 Mechanical heart valves
 Calcific aortic stenosis
 March ha...
 A 40 yr old male comes to us with c/o of
fatigue ,breathlessnesssince 2 months
History
 Complains-breathlessness
 fatigue
 fever
 Stool color
 Urine color
 H/O recent blood transfusion,recent
inf...
Clinical examination-
Anaemia
Icterus,
Jaundice
Fever
Splenomegaly
HOW TO APPROACH
CONTINUED….
PEREPHERAL BLOOD SMEAR
 THANK YOU
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemia
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Approach to a patient with hemolytic anaemia

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Dr sunil Bhatt MD medicine

Published in: Health & Medicine
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Approach to a patient with hemolytic anaemia

  1. 1. MODERATOR-DR.AMIT VARMA PRESENTAOR –DR.SUNIL BHATT
  2. 2.  Normal shape of RBC- biconcave  Normal life span of RBC-120 day
  3. 3.  Hemolytic anemia is a form of anemia due to haemolysis ,the abnormal premature breakdown of red blood cells (RBCs)either in the blood vessel (intravascular haemolysis)or elsewhere in the human body(extravascular ) and bone marrow is not compensating for red blood cell loss.
  4. 4. Compensatory action of bone marrow  In response to haemolytic anaemia –dec haemoglobin  Oxygen supply to kidney is dec,  Inc erythropoiten from peritubular capillaries around PCT  Erythropoiten prevents apoptosis of erthroblast .causes erythroid hyperplasia  Bone marrow can inc prod.of RBC 8 to 10 times.  (compensated haemolytic disease)
  5. 5. evidence of haemolyis Jaundice due to unconjugated hyperbilirubinemia.  jaundice is mild to moderate.  lemon yellow color of skin(Pale color of aneamia and yellow color of jaundice )  Dark color stool  Inc urobilinogen in urine(acholuric jaundice)  LDH level are raised  Haptoglobin (macrophages destroy haptoglobin and haemoglobin)  Slightly less haptoglobin in extravascular  Very less haptoglobin in intravascular.
  6. 6. PERIPHERAL BLOOD FILM evidence of haemolysis  Normal reticulocyte count in blood is 1 to 2%  In haemolysis reticulocyte count is upto 20%  MCV-Increses(105fl)normal is 80 to 100fl  Macrocytosis  Polychromasia(multiple color and shade)  BONE MARROW  Hypercelluar bone marrow
  7. 7. EXTRAVASCULAR OR INTRAVASCULAR extravascular  SPLENOMEGALY  intravascular  dec haptoglobin or absent haptoglobin  Haemoglobinemia  Methaemoglobinemia  Tetrameric to dimer structure of haemoglobin -- endocytosis by PCT cells ---release of iron-- Acute tubular necrosis –renal failure  Haemoglobinurea.
  8. 8. FEATURES OF EXTRAVASCULAR HAEMOLYSIS(HERIDITARY SPHEROCYTOSIS) PBF  MCV –DEC  MCH -NORMAL  MCHC –HIGH  RBC SHAPE –SPHERICAL  RBC COLOR- DARK RED WITH LOSS OF CENTRAL PALLOR  OTHER FINDINGS  SPLENOMEGALY
  9. 9. ACUTE OR CHRONIC intravascular haemolysis ACUTE Haemoglobinemia, methaemoglobinemia, low haptoglobin Haemoglobinuria CHRONIC Deposition of bilirubin in gall bladder—gall stones. Splenomegaly. Haemosiderinurea—due to chronic haemolysis haemosiderin is formed in PCT.Stained by persian blue.
  10. 10. Intrinsic and extrinsic causes  INTRINSIC CAUSES –cause is related to RBC itself.  EXTRINSIC CAUSES-where factors external to the RBC dominate.
  11. 11. Intrinsic causes  INHERITED  Membrane defects  Enzymes defect
  12. 12. INTRINSIC CAUSES INHERITED  Heriditary spherocytosis  Heriditary elliptosytosis ACQUIRED  PNH
  13. 13. PNH  Acquired  Mutation of myeloid cells  On x chromosomes on short arm  PIG-A gene-GPI PHOSPHOLIPIDS on cell membrane which is attached to PIG tailed protein(CD55,CD59,C-8 BINDER)  Haemolysis of RBC,WBC and platelets.  HAEMOTOLOGICAL CHIMERA  ASSOSIATION WITH APLASTIC ANAEMIA  AUTOREACTIVE REACTIVE T CELLS DESTROYS THOSE MYELOID CELL WHICH ARE LOADED WITH NORMAL GPI PROTEIN WHICH WILL CAUSE CELLS DEFICIENT IN GPI WILL PROLIFERATE.THESE PATHOLOGICAL CELLS WILL MULTIPLY.  In severe case pancytopenia
  14. 14.  Haemolysis occur all the time  During sleep occurs more  Breathing become slow –inc in co2---produce acidic enviornment-alternate compliment acivated.  Thrombi formation(hepatic vein,cerebral vein,deep vein of legs)  Free Hb combine with NO  Smooth muscle fail to relax—erectile dysfuntion,odynophagia  Inc infection  LAP score dec  TESTS  HAM TEST  SUCROSE HAEMOLYSIS TEST  FLOW CYTOMETRY  IMMUNOSUPPRESIVE DRUGS  MONOCLONAL ANTIBODIES—BINDS WITH C5 PREVENTS BREAKDOWN OF C5 TO A AND B COMPONENT.
  15. 15. Enzyme defect  Hexokinase  Pyruvate kinase  G6PD Deficiency  Glutathione synthese Glycolysis pathway disturbed
  16. 16.  Haemoglobin synthesis defect  GLOBIN CHAIN SYNTHESIS IS QUANTITATIVELY REDUCED  THALASEMIA(ALPHA OR BETA )  QUALITATIVE DEFECT IN GLOBIN CHAIN  HAEMOGLOBINOPATHIES  SICKLE CELL ANAEMIA(GENE defect POSITION NO 6 .GLUTAMIC ACID IS REPLACED BY VALINE)
  17. 17. Extrinsic causes  Immune mediated causes like ISO ANTIBODY---ABO ,Rh AUTO ANTIBODY--- Warm cold agglutinins cold haemolysins
  18. 18. WARM ANTIBODY  IgG  37 DEGREE CENTIGRADE  DIRECTED AGAINST -Rh antigen  Monomeric cannot agglutinate  Compliment system cannot be activated(RBC has cd59 and cd55)  RBC when they pass through spleen converts to spherocytes.(differentiated by direct coombs test)  Cause- idiopathic,lymphoma,leukemia,SLE,drugs(penicillin,cepha losparin,quinidine,alpha methyl dopa)
  19. 19. Cold antibody  IgM  Agglutinate  <37 degree centigrade  I antigen  Works only when peripheral parts are exposed to cold tempreture.  Acrocyanosis due to clogged blood vessels by clumpped RBC  Activates compliment partially in periphery.  Agglutinin disintegrates in the warmer parts of the body.  C3b coated RBC are destroyed more in liver and les in spleen.  Doing splencetomy is not useful.  Treatment is keeping the periphery warm.  CAUSE-idiopathic,lymphoma ,mycoplasma pneumoniae,IM
  20. 20. Cold haemolysin  <37 degree centigrade  IgG  P component in RBC sticks to rbc at lower temp in extremities  Activates compliment at warmer tempreture  Intravacular haemolysis  Haemoglobinemia  Haemoglobinurea  Discovered in tertiray syphillis by Dr.Donath LANDSTEINER  Measles mumps
  21. 21. Non immune mediated  Macro angiopathic haemolytic anaemia  Mechanical heart valves  Calcific aortic stenosis  March haemoglobinuria,bongo drummers  Micro angiopathic haemolytic anaemia  Fibrin thrombi --DIC  Platelet thrombi—TTP,HUS(E COLI O157:H7)  Splenic sequestration  Chemical injury  Infections  Malaria  Clostridium-lecithinase
  22. 22.  A 40 yr old male comes to us with c/o of fatigue ,breathlessnesssince 2 months
  23. 23. History  Complains-breathlessness  fatigue  fever  Stool color  Urine color  H/O recent blood transfusion,recent infection,exposure of drugs or toxins,cardiac prosthesis valve
  24. 24. Clinical examination- Anaemia Icterus, Jaundice Fever Splenomegaly
  25. 25. HOW TO APPROACH
  26. 26. CONTINUED….
  27. 27. PEREPHERAL BLOOD SMEAR
  28. 28.  THANK YOU

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