PowerPoint Presentation - Week 2: Hemolytic Anemia
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Week 2: Hemolytic Anemia
Normocytic anemia
Fanconi anemia
Diamond-Blackfan
(PRCA)
Types of hemolysis
Evidence of hemolysis
Reticulocyte
G6PD deficiency
Heinz bodies
PK deficiency
Cytoskeleton
Spherocytosis
Elliptocytosis
PNH
Normocytic Anemia
Acute hemorrhage
Hypo-proliferative
Acquired aplastic anemia
Constitutional aplastic anemia
Pure red cell aplasia (PRCA)
Acute Hemorrhage
No changes in CBC until plasma volume
increases
Later, reticulocytosis
Hypoproliferative Anemia
Pancytopenia
< 25% BM cellularity
Low retic count
Bone marrow defect
Immunologic suppression
Growth Factor deficiency
Abnormal stem cells
Acquired Aplastic Anemia
Idiopathic
Drugs and chemicals (eg, chloramphenicol,
benzene, insecticides)
Radiation
Virus
Paroxysmal nocturnal hemoglobinuria
Constitutional Aplastic Anemia
Fanconi’s anemia
Chromosomal breaks
Pure Red Cell Aplasia PRCA
Infections
Drugs
Diamond-Blackfan syndrome
No EPO deficiency
Hemolytic Anemia
Intravascular vs extravascular
Bilirubin metabolism
Types
Membrane defect
Metabolic defect
Extracorpuscular
Evidence of Hemolysis
Low RBC survival with chromium tagging
study
Unconjugated bilirubin
Plasma Hb
Decreased serum haptoglobin
Evidence of Erythropoiesis
Polychromasia
Increased reticulocyte
“Shift” macrocytosis
Hypercelluar BM
Correcting Retic Count
Retic Index = Retic % x
Patient Hct
Normal Hct
Absolute Retic = Retic % x RBC/mm3
Retic Production Index =
Retic Index
Days in circulation
Membrane Defect
Spherocytosis
Elliptocytosis
PNH (sensitivity to complement lysis -sugar water test, Ham’s test)
Stomatocytosis (possibly Rh null)
Spherocytes
Elliptocytes
Osmotic Fragility
Paroxysmal Nocturnal Hemoglobinuria
Hematopoietic stem cell disorder
Mutation of phosphatidylinositol glycan class A
(PIG-A) gene
Glycosylphosphatidylinositol (GPI) anchors
membrane proteins
Without GPI, unable to regulate completment
activities on membrane
Hemolysis is pH dependent
Thrombosis can occur
Lab Tests for PNH
Acidified serum lysis test (Ham’s test): PNH cells
lyse due to complement activation in acidified
serm
Sugar water (sucrose hemolysis) test: RBCs
sensitive to complement will lyse in sucrose and
serum
Flow cytometry: lack of CD59 on RBCs, or lack
of CD59 or CD55 on granulocytes
Stomatocytes
Metabolic Defect
G6PD deficiency
Hexose
monophosphate shunt
Most common RBC
enzyme defect, >50
variants
X-linked
Low glutathione due to
low NADPH
Oxidative lysis, Heinz
bodies, spherocytic
Primaquine, fava beans
Pyruvate kinase deficiency
Glycolysis
Low RBC ATP level
Non-spherocytic
B12 and folate deficiency
Macrocytic
HJ bodies
Hemoglobinopathies
Poikilocytosis
Abnormal Hb
Heinz body preparation with Crystal violet
Unstable hemoglobin
Extracorpuscular Factors
Antibodies
Autoimmune
Isoimmune
Drugs, antibiotics
Fresh water
Abnormal plasma
lipids
Acanthocytosis
Venom
Snake
Spider
Bee
Extracorpuscular Factors
Trauma
DIC
Hemolytic uremic
syndrome (HUS)
TTP
Angiopathy
Heat
Heart valves
“March”
hemoglobinuira
Microorganisms
Malaria
Babesia
Clostridium
Gram negative
endotoxin
Schistocytes
Malaria