Noon conference 10 1-18
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This document summarizes a noon conference on hemolytic anemia. It discusses the presentation, diagnostic approach, and treatment of drug-induced hemolytic anemia specifically. Key points include that drug-induced anemia can be oxidative or immune-mediated, with oxidative stress converting hemoglobin to methemoglobin. Phenazopyridine is highlighted as a common culprit that can cause both hemolysis and acute renal failure. Methemoglobinemia is also covered, noting symptoms of cyanosis and dark blood despite normal oxygen levels. Treatment depends on methemoglobin percentage and G6PD deficiency status, using methylene blue or ascorbic acid as indicated.
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Anemia-MS3-Mandernach.ppt54545454557747477
This document provides an overview of anemia and presents 5 case studies. The key points are:
1) Anemia is defined as a reduction in red blood cells (RBCs), hemoglobin, or hematocrit. Causes can be classified based on RBC size as microcytic, normocytic, or macrocytic.
2) Case 1 describes an autoimmune hemolytic anemia in a woman with symptoms of jaundice and splenomegaly. Testing confirms a warm antibody hemolytic anemia related to an underlying autoimmune disorder.
3) Case 2 involves a asymptomatic woman with a microcytic anemia and normal iron studies who is found to have alpha thalas
Anemia-MS3-Mandernach.pptghjgjgyyuigguguh
The document provides an overview of anemia and presents several case studies. It defines anemia, discusses initial laboratory evaluation and additional tests. It then describes 5 cases of patients presenting with anemia. Case 1 involves a woman with autoimmune hemolytic anemia. Case 2 is a woman with alpha thalassemia. Case 3 is a woman diagnosed with acute myeloid leukemia. Case 4 is a woman with thrombotic thrombocytopenic purpura. Case 5 is a man with renal failure and anemia of chronic inflammation.
Approach to Hemolytic Anemia
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
Clinical pathology spots for final MBBS
Clinical pathology spots for final MBBS. With some sample questions & answers to guide medical students.
BloodTransfussionGuidelines.pdf
This document provides guidelines for blood transfusion, including:
1. It discusses the selection and preparation of blood products such as whole blood, platelet concentrates, fresh frozen plasma, and packed red blood cells. Proper donor requirements, collection procedures, and storage conditions are outlined.
2. Indications, dosing, and expected responses to transfusions of various blood components are covered. Red blood cell and platelet transfusion thresholds and dosing are provided.
3. Safety procedures for blood typing, cross-matching, and transfusion monitoring are described. Special considerations for patients with conditions like autoimmune hemolytic anemia that could cause transfusion reactions are highlighted.
4. Two case illustrations demonstrate the
Hematology Case Presentation of a 28 years old Female .pdf
A 28-year-old female presented with body malaise, yellowish discoloration of the sclera, and tea-colored urine. Her vital signs showed tachycardia and her sclera were icteric. Laboratory tests found elevated liver enzymes and bilirubin. The working diagnosis is acquired immune hemolytic anemia secondary to her known systemic lupus erythematosus. Differential diagnoses considered include drug-induced hepatitis and aplastic anemia. Treatment may include corticosteroids, rituximab, intravenous immunoglobulin, or splenectomy to treat the underlying autoimmune hemolytic anemia.
Anemia and Blood Transfusions
This document discusses anemia, blood transfusions, and transfusion reactions. It defines anemia as a decrease in oxygen-carrying capacity of blood and notes normal hemoglobin ranges. It also describes different types of blood products including packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. The document outlines indications for transfusing each product and notes storage requirements. It discusses potential transfusion complications such as hemolytic, febrile, allergic, and circulatory overload reactions. The document also covers massive transfusion protocols.
Hepatorenal syndrome
Hepatorenal syndrome is a condition characterized by impaired renal function in patients with advanced liver disease and portal hypertension. There are two types - type 1 is rapid and progressive, leading to death within a month without treatment, while type 2 is less severe but still associated with worse prognosis. The pathogenesis involves splanchnic vasodilation triggering renal vasoconstriction. Treatment involves vasoconstrictors like terlipressin combined with albumin to increase mean arterial pressure and improve renal function. Achieving at least a 10 mmHg increase in MAP with vasoconstrictor therapy correlates with better renal outcomes in hepatorenal syndrome patients.
clinical.pptx
The document describes 14 clinical cases presenting with various types of anemia. For each case, the patient's history, symptoms, lab results and differentials are provided. The cases cover different anemias including iron deficiency, aplastic, autoimmune hemolytic, thalassemia trait, chronic lymphocytic leukemia, chronic myeloid leukemia, lymphoma, liver disease-related, and thrombotic thrombocytopenic purpura. Management workup and next steps are discussed for each clinical scenario.
Acquired hemophilia A case presentation.pptx
1) A 32-year-old female presented with spontaneous bruising and small hematomas over the past 5 months without a history of bleeding issues.
2) Testing revealed an elevated aPTT that corrected on mixing studies but became prolonged again after 2 hours of incubation, consistent with an acquired factor VIII inhibitor.
3) She was diagnosed with acquired hemophilia A, which is treated initially with bypassing agents for bleeding and corticosteroids alone or with cyclophosphamide to eliminate the inhibitor.
peripheral smear anemea clues.pdf
The document discusses the importance of peripheral smear examination in diagnosing different types of anemias. It provides examples of various cases where examining peripheral smear clues helped arrive at accurate diagnoses, including thalassemia major, megaloblastic anemia, hemolytic anemias like hereditary spherocytosis, autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura and sickle cell anemia. It emphasizes that describing a smear as hemolytic anemia is incorrect and the cause of hemolysis must be identified. Seeing schistocytes is also highlighted as a critical finding requiring urgent therapy.
Transfusion Reaction.pptx
This document discusses various types of transfusion reactions, their causes, signs and symptoms, investigations, management, and prevention. It describes hemolytic transfusion reactions caused by ABO incompatibility or other antibodies which can be acute and life-threatening or delayed. Non-hemolytic reactions include febrile non-hemolytic reactions, allergic reactions, anaphylaxis, circulatory overload, and graft-versus-host disease. Investigations of transfusion reactions include blood samples, urine analysis, and cultures to identify the cause and guide appropriate treatment.
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Hematology Case Presentation of a 28 years old Female .pdf
Hematology Case Presentation of a 28 years old Female .pdf
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Noon conference 10 1-18
- 2. Hemolytic Anemia • Discuss disease presentation • Discuss diagnostic approach • Discuss Hemolytic Anemia due to drug toxicity • Methemoglobinemia and Treatment • Review illness script
- 3. History and Physical Exam History • Rapid onset of symptoms of anemia in absence of bleeding • Recent blood transfusion • Recent intiaition of new medication • Family hx • Gallstone history Physical Exam: • Jaundice is consistent with brisk hemolysis • Dark urine (if intravascular hemolysis) • Splenomegaly
- 4. Diagnostic Approach • Labs: Reticulocyte count (corrected retic count), LDH, Low haptoglobin*, increased unconjugated bili. • Patient has anemia and evidence of hemolysis Ensure no urgent interventions required Ensure no recent transfusion last 4 weeks • Look for evidence of chronic inherited causes such as thalassemia or SS blood smear results • Common Causes are AIHI, drug induced and infections • Direct Antiglobulin (Coombs) test (DAT) • Positive – AIHI distinguish between warm and cold AIHI • Negative – AIHI unlikely, Look for other disorders based on hx and exam • i.e. new medication, heart valve, signs of aortic stenosis, fever etc. *Haptoglobin is acute phase reactant, not always low in acute illness
- 5. Drug Induced hemolytic anemia • Oxidative vs Immune • Oxidation of hemoglobin to Methemoglobin (Hb Fe3+) • Ferric heme molecules are unable to bind oxygen. • The accompanying ferrous hemes have a higher affinity for O2 • Shifts the hemoglobin dissociation curve to the Left • Oxidative stress precipitates hemoglobin as Heinz bodies • Producing bite cells • Predominantly intravascular hemolysis • Plasma free hemoglobin or UA to distinguish
- 6. Phenazopyridine • A bladder analgesic associated with oxidative hemolysis • Recommended max duration is 2 days • Patient commonly are given prescriptions for 1-4 weeks • Acute renal failure is common in setting of hemolysis • Can also produce acute renal failure directly • Side effects of note: • Urine discoloration – reddish orange • Skin discoloration – Yellow • should be d/c if occurs
- 7. Methemoglobinemia • Presentation: Headache, fatigue, dyspnea and lethargy. Cyanosis in setting of normal arterial PO2 on ABG. Dark red or brownish blood. Inaccurate Pulse Oximetry. • High concentration cuases display of 85% regardless • Blood gas analysis measurements overpredict the saturation • Diagnosis: • Methemoglobin assay • Treatment • Levels >20% are associated with sxs • If <20% and asymptomatic d/c offending agent only • If >20% or symptomatic can use ascorbic acid or MB. • 1-2mg/kg over 5 min repeated if necessary
- 8. What is the preferred treatment in patients with and without G6PD deficiency? • MB/MB • MB/Ascorbic Acid • Ascorbic acid/MB • Ascorbic Acid/Ascorbic Acid • Ascorbic Acid/Blood Transfusion
- 9. © 2016 Virginia Mason Medical Center Illness Scripts 9 Hemolytic anemia due to drug toxicity Pathophysiology Oxidative stress, conversion to HbFe3+ resulting in Heinz bodies and hemolysis Epidemiology G6PD deficient patients at higher risk Time course Variable Clinical presentation Fatigue, generalized weakness, Dyspnea, back pain, dark urine, jaundice, hemoglobinuria recent initiation of new drug Cyanosis and dark red blood if symptomatic HbFe3+ Diagnostics Labs: Reticulocyte count (corrected retic count), LDH, Low haptoglobin*, increased unconjugated bili, blood smear, DAT, H/H, Creatinine, ABG, Methemoglobin percent Other testing: G6PD enzyme deficiency Specimen: UA: heme positive without RBCs Therapeutics Remove offending agent, supportive care with transfusions Hb<7 MB or Ascorbic Acid if Methemoglobin >20%
Editor's Notes
- purpuric rash may suggest so-called “double-positive” patients who have concurrent ANCA-associated vasculitis (granulomatosis with polyangiitis).