7: Haemolysis

Question 1

What are the products of red blood cell breakdown?

Answer 1

Iron

Bilirubin

Amino acids

Question 2

How long does a red blood cell normally last in the circulation?

Answer 2

120 days

Question 3

What is haemolysis?

Answer 3

Premature RBC destruction

Question 4

What shape are red blood cells?

Answer 4

Biconcave

Greater surface area, allows them to squeeze through bone marrow and high pressure circulation

Question 5

Which organelles do red blood cells lack?

Answer 5

Nucleus

Mitochondria

Question 6

What process compensates for haemolysis?

Answer 6

Erythropoiesis

i.e RBC production

Question 7

In compensated haemolysis, ___ concentration is maintained within normal limits.

Answer 7

Hb

Question 8

In ___ haemolysis, Hb concentration decreases.

Answer 8

decompensated haemolysis

Question 9

What change occurs in the bone marrow secondary to haemolysis?

Answer 9

Hyperplasia

Question 10

What clinical sign can be seen in patients with haemolysis?

Answer 10

Jaundice

Increased levels of bilirubin

Question 11

Which kind of cells are seen in increased numbers in the bone marrow in response to anaemia?

Answer 11

Reticulocytes

Reticulocytosis

Question 12

Why do reticulocytes stain blue-grey (polychromatic) on a blood film?

Answer 12

They still have RNA

Producing cells of different colours, i.e a polychromasia

Question 13

Is reticulocytosis only seen in haemolytic anaemia?

Answer 13

No

Bone marrow response to anaemia - bleeding, iron deficiency etc.

Question 14

How are reticulocytes described when stained on a blood film?

Answer 14

Polychromatic

Question 15

What is erythroid hyperplasia?

Answer 15

Increase in bone marrow cell number in response to EPO

Question 16

In which organs can red blood cells be broken down?

Answer 16

Spleen

Liver

Question 17

Apart from the spleen and liver, where can red blood cells be broken down?

Answer 17

Circulation

Question 18

(Intravascular / Extravascular) haemolysis is more common.

Answer 18

Extravascular haemolysis more common

Question 19

What happens to the organs in which haemolysis occurs?

Answer 19

Increase in size

so producing splenomegaly, hepatomegaly

Question 20

What are the RBC products released in extravascular haemolysis?

Answer 20

Normal products

i.e bilirubin, iron and amino acids

Question 21

Intravascular haemolysis is a (normal / abnormal) process.

Answer 21

abnormal

so the products released are abnormal as well and you get symptoms like pink urine

Question 22

Patients given which type of blood transfusion can develop haemolysis?

Answer 22

Incorrect group

Question 23

Which enzyme deficiency, increasing oxidative stress exerted on red blood cells, can cause haemolytic anaemia?

Answer 23

G6PD deficiency

Question 24

Which infection can cause haemolytic anaemia?

Answer 24

Malaria

Question 25

What are the two types of haemolytic anaemia?

Answer 25

**Intravascular** **Extravascular**

Question 26

What is the most common **inherited disorder** causing haemolytic anaemia in the UK?

Answer 26

**Hereditary spherocytosis**

Question 27

Haemolytic anaemia is commonly caused by ___ disease.

Answer 27

**autoimmune disease**

Question 28

Which connective tissue disease can cause autoimmune haemolysis?

Answer 28

**SLE**

Question 29

Autoimmune haemolysis is caused by either ___ or ___ autoantibodies.

Answer 29

**warm or cold**

Question 30

What type of antibody are **warm** AH antibodies?

Answer 30

**IgG** more common than cold

Question 31

Which test is used to diagnose **warm autoimmune haemolysis**?

Answer 31

Coombs test Should be +ve

Question 32

What type of hypersensitivity reaction is a blood transfusion reaction?

Answer 32

**Type II** Antibody-mediated

Question 33

What causes most haemolytic disease in newborns?

Answer 33

**Rhesus reaction** RhD- mother receives RhD+ blood from baby (haemorrhage, birth etc.), autoantibody response which then goes back to baby causing haemolysis Avoid with anti-D injections

Question 34

Which specific GI infection may cause acquired haemolytic anaemia?

Answer 34

**E. coli 0157**

Question 35

Why can **implanted heart valves** cause haemolysis?

Answer 35

**Mechanical damage to RBCs** i.e cells bouncing off metal

Question 36

Problems with which part of a red blood cell can cause haemolysis?

Answer 36

**Cell membrane**

Question 37

What is the most common inherited condition causing haemolytic anaemia? What cell structure does it affect?

Answer 37

**Hereditary spherocytosis** **Cell membrane**

Question 38

Which molecule keeps iron in its **ferrous** (Fe2+) form in red blood cells?

Answer 38

**NADPH**

Question 39

Which cause of **increased oxidative stress** can cause haemolysis?

Answer 39

**G6PD deficiency**

Question 40

Which derm condition is associated with **Coeliac disease**?

Answer 40

**Dermatitis herpetiformis**

Question 41

Which treatment for **dermatitis herpetiformis** is associated with haemolysis?

Answer 41

**Oral dapsone**

Question 42

Which disease affecting the **structure of haemoglobin** can cause haemolysis?

Answer 42

**Sickle cell disease**

Question 43

What haematological disorder is **frontal bossing** associated with?

Answer 43

**Beta thalassaemia**

Question 44

**Blood transfusion** reactions are a cause of **(extravascular / intravascular) haemolysis**.

Answer 44

**intravascular**

Question 45

What are the signs and symptoms of **hereditary spherocytosis?**

Answer 45

**Intermittent jaundice** **Gallstones** **Splenomegaly \> Splenectomy at young age**

Question 46

**Malaria** causes **(extravascular / intravascular) haemolysis**.

Answer 46

**intravascular haemolysis**

Question 47

What is **HbH** **disease?** What is **HbH**?

Answer 47

**Form of alpha thalassaemia** (3 out of 4 genes deleted) **Crap form of Hb with 4 beta chains** **Flare ups with stress, drugs**

Question 48

What is the definition of **haemolysis**?

Answer 48

**PREMATURE RED CELL DESTRUCTION**