120914 intro to hemolytic anemias

Question 1

hemolytic anemias result in

Answer 1

loss of RBC mass

release of cellular contents

Question 2

another name for inherited disorders of hemolytic anemia

Answer 2

intrinsic

Question 3

lab eval of hemolysis in general–what is the cell size?

Answer 3

usually normocytic anemia

Question 4

lab eval of hemolysis in general–what do you see?

Answer 4

normocytic anemia
reticulocytosis
increased LDH, AST, K
bilirubinemia
hemoglobinemia (free hemoglobin in plasma)
DAT (direct antiglobulin test)

hemoglobinuria (mostly in intravascular processes)
hemosiderinuria (mostly in intravascular processes)-iron deposits in renal epithelium then shed in urine

Question 5

what gives you red plasma?

Answer 5

hemolytic processes

Question 6

young pts with chronic hemolytic conditions–what symptoms do you see?

Answer 6

can often tolerate extreme anemia with minimal symptoms

Question 7

how are acute changes in RBC volume tolerated in the case of hemolytic anemia when starting with a normal hemoglobin?

Answer 7

poorly

Question 8

jaundice is detectable in fair skinned individuals when bilirubin exceeds

Answer 8

2.5 mg/dL

Question 9

RARE complications of hemolytic anemia

Answer 9

pigment (heme) induced kidney injury
folate deficiency (due to increased utilization)
increased risk of venous and arterial thrombosis (when RBCs shear)

Question 10

clinical features of hemolytic anemia related to underlying disease process

Answer 10

splenomegaly, hepatomegaly related to extramedullary hematopoiesis (thalassemia, PK deficiency, hereditary spherocytosis)

skeletal changes related to expansion of marrow-chipmunk facies, convex bones (beta thlassemia major)

asplenia (sickle cell anemia-infarcts the spleen)

microangiopathic hemolytic anemia (TTP, HUS, DIC, malignant HTN, etc)