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Haem13 hemolytic anemia - acquired

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Acquired hemolytic anemias.

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Haem13 hemolytic anemia - acquired

  1. 1. Never say No, never say, ‘I cannot’, for you are infinite. Even time and space are as nothing compared with your nature. You can do anything and everything. -- Swami Vivekananda
  2. 2. ….. foundation of clinical medicine Shashidhar Venkatesh Murthy A/Prof & Head of Pathology College of Medicine & Dentistry Clinical Pathology: RBC 1.3: Hemolytic Anemia - Acquired CPC : Term2 Week1 - Haem 1/2. System : Haematology - RBC Disorders. Topic : 1: Anemia Intro 2: IDA, MBA & ACD 3: Acquired HA 4: Congenital HA. 5: Others.
  3. 3. Pathogenetic Classification of Anemia:  Decreased Production:  Nutrient Deficiency.  Iron def (IDA) / Megaloblastic (MBA)  Hemopoietic cell defect:  Anemia of chronic disorders (ACD)  Aplastic anemia (AA).  Dysplastic anemia. Myelodysplastic Syndromes  Increased loss / destruction:  Blood loss anemia – Acute / Chronic - bleeding.  Hemolytic anemia – Congenital / Acquired.  Acquired / External injury.  Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites  Congenital / Internal RBC defect  Defective Membrane (Spherocytic an)  Defective Hemoglobin (Sickle cell an.)  Deficient Enzyme (G6PD) 3 2 Top 6 Anemias: 1. Iron Def. A 2. Megaloblastic 3. Anem. Of Chronic Dis. 4. Aplastic An. 5. Immune Hemolytic – Warm 6. Immune Hemolytic - Cold
  4. 4. Haemolytic Anemia: Introduction  Anemia due to Increased RBC destruction   life span (<120d) - Abnormal forms  Bilirubin  Jaundice (Unconjugated)   RBC production – BM Hyperplasia &  Reticulocytes.  Acute: Pallor, Jaundice (normal urine)  Chronic: Splenomegaly, pigment gall stones.  Intravascular & Extravascular Hemolysis*. Jaundice 2. Jaundice 4. Splenomegaly 3. Pigment Gall stones 1. Pallor Immune Mech. Infection Porphyrin  Bil. Unconj Globins Iron Bil. Conj Conjugation Normal
  5. 5. Intravascular Hemolysis.  Etiology:  Immune, Mechanical, Enzyme def. transfusion mismatch, drugs, infections.  Lab diagnosis:  Absent Haptoglobins.  Haemoglobinemia  Haemoglobinuria  Haemosiderinuria  Clinical features:  Shock,  Renal failure, In Extravascular Hemolysis: Unconjugated hyperbilirubinemia only* 5 Breakdown of RBC within Blood Vessel Renal failure
  6. 6. FBC Result: Hemolytic Anemia. 6
  7. 7. Hemolytic anemia: Morphology 7  Abnormal RBC shapes spherocytes in WIHA, target forms in thalasssemia etc.  Polychromatophils. (Immature RBC - large, bluish, no central palor - Reticulocytes)  Nucleated RBC small nucleus inside reticulocyte. Thalassemia Warm Ab Hemolytic Anemia Giems stain (routine blood film)  Bluish, Large RBC ( MCV)
  8. 8. Hemolytic Anemia:  Reticulocytes Reticulocyte RBC Reticulocytosis  Increased RBC production Methylene blue stain for cytoplasmic RNA Giemsa stain (routine blood film)  Bluish, Large RBC ( MCV)
  9. 9. Only educated person is one who has learned how to learn and change. -- Carl Rogers
  10. 10. Cell Mem Hb Enzymes Haemolytic Anemia: classification  Acquired / External Injury:  Immune: IgG / Warm & IgM / Cold  Physical: valve dis, March Hb.nuria, trauma, burns.  Drugs: α-Methyldopa, cephalosporins, ibuprofen etc.  Parasites / infections (malaria, septicemia (DIC)  Congenital / Internal defects:  Defective Membrane: Spherocytic anemia.  Defective Haemoglobin: Sickle cell anemia, Thalassemia  Deficient Enzyme: G6PD deficiency anemia. 10
  11. 11. Immune Hemolytic anemia IgG/IgM: 11  Causes:  RBC Antibody (Commonest.)  Pathogenesis:  Warm / IgG coated RBC lysis in spleen. Drugs, Idiopathic. (predominantly extravascular)  Cold / IgM - (Infections, Lymphoma) RBC Clumping & complement fixation lysis in BV & Liver. (predominantly intravascular)  Morphology:  Spherocytes (warm) / RBC clumps (cold).  Clinical Features:  Anemia, Jaundice. Splenomegaly in chronic.  Diagnosis: Comb’s test *. IgG WARM IgM COLD WARM / IgG COLD / IgM IgG Antibody
  12. 12. AIHA: Lab diagnosis – Coombs test. 12 Direct Coombs Test: (for antigen on patient RBC) Indirect Coombs Test: (for antibodies in the serum.) Pos Neg Online Video Tutorial Patient RBC Patient Serum
  13. 13. MAHA - Microangiopathic Hemolytic An. Mechanical damage: Etiology:  DIC, TTP, HUS  Valve disease / Artificial valves.  March Hemoglobinuria. Morphology:  Fragmented RBC: Schistocytes.  Polychromasia – reticulocytes. 13
  14. 14. 14 The only person who never makes a mistake is a person who never does anything…! - Theodore Roosevelt
  15. 15. Need help? contact me… 1. Office location: DB39-136 (Townsville) 2. Office Tel: 4781 4566 3. Email: venkatesh.shashidhar@jcu.edu.au 4. Emergency?: 0416933704 Need personal coaching? Email me for an appointment. You are the stone..
  16. 16. The pessimist waits for better times, and expects to keep on waiting; the optimist goes to work with the best that is at hand now, and proceeds to create better times. -- Christian D. Larson

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