Haem - haemolytic anaemia + anaemia generally Flashcards
Causes of extravascular haemolytic anaemia?
Autoimmune causes + hereditary spherocytosis
Features of intravascular haemolytic anaemia?
Dark red urine (haemoglobinuria) Low haptoglobin (binds free Hb)
Inherited causes of haemolytic anaemia
Membrane: spherocytosis, elliptocytosis
Enzyme: G6PD, pyruvate kinase deficiency
Hb: sickle cell, thalassemia
Acquired causes of haemolytic anaemia
Immune or non-immune
Immune: Autoimmune(hot or cold) or alloimmune
Non-immune: malaria, MECHANICAL, PNH, MAHA
Which test should be done to determine if haemolytic anaemia is immune or non-immune?
DAT test
Warm autoimmune haemolytic anaemia.
List 5 causes?
Idiopathic - most common Lymphoma CLL SLE methyldopa
3 point plan re management of warm autoimmune haemolytic anaemia?
Steroids
Splenectomy
Immunosuppression
Which Ig class is implicated in warm AIHA? and in cold AIHA?
Warm = IgG Cold = IgM
4 causes of cold agglutinin disease?
Idiopathic
Lymphoma
Mycoplasma
EBV
Which chemotherapy drug is used for cold agglutinin disease?
Chlorambucil
Management of PNH - 3 marks
1) Iron/folate supplements
2) Monoclonal Abs against complement
3) Prophylactic vaccines/Abx
MAHA - 4 causes?
HUS
TTP
DIC
Preeclampsia
Cause of HUS? How does MAHA develop?
E. Coli –> toxin damages endothelial cells
Fibrin mesh forms –> mechanical damage of RBCs!
Classical 5 features of TTP?
MAHA Fever renal failure Low plts Neuro abnormalities!!!! - not seen in HUS
3 features of HUS?
Haemolysis
Renal failure/uraemia
Thrombocytopenia
How are HUS and TTP linked
anyone with TTP has HUS (all 3 features of HUS + fever + neuro sx = TTP)
TTP vs HUS - which one is more likely in children?
HUS
How can one distinguish between DIC and TTP?
DIC has prolonged APTT and PT
Paroxysmal nocturnal haemoglobinuria - key features?
Haemoglobinuria in the morning
- low haptoglobin
- high free serum Hb
- high LDH
What should you look for to diagnose a patient with heparin induced thrombocytopenia?
Heparin use lol
- Low platelets lol
- haemolysis
- renal failure/uraemia
i.e. Heparin + HUS
7 features of DIC
Haemolysis Low platelets Renal failure/uraemia Neuro changes Fever Prolonged APTT prolonged PT
Abnormal RBCs seen in a crisis of a pt with G6PD deficiency
Heinz bodies
3 egs of when you may see pencil cells in a blood film
IDA
thalassemia
Pyruvate kinase deficiency
Target cells - causes?
3Hs: hyposplenism, hepatic failure, haemoglobinopathies
Spherocytes - what can cause this? other than hereditary spherocytosis duh
Autoimmune haemolytic anemia
Acanthocytes - what do they look like? What can cause it?
Spiky RBCs. Abetalipoproteinaemia, liver disease
What is basophilic stippling?
purple spots in cytoplasm of RBCs, they are rRNA remnants
Underlying condition in basophilic RBC stippling?
Haemoglobinopathies
Megaloblastic anemia
Main cause of Heinz bodies
G6PD DEFICIENCY
Main cause of rouleaux
Myeloma
Pelger-Huet cells - what even is it? What is the cause?
Hyposegmented neutrophils
Myelodysplastic syndromes
Howell-Jolly bodies: what do they look like?
purple spot in the centre of an RBC
2 major causes of howel jolly bodies
Hyposplenism
Megaloblastic anemia
In IDA, which 2 measurements goes UP and why
Transferrin: transports iron, so when iron is low, the liver increases transferrin production to bind to as much available iron it can
TIBC
Name of the Neuro issue which develops following B12 deficiency?
Subacute Combined Degeneration of the cord (SACD)
= Loss of proprioception + loss of touch + ataxia .
Spinothalamic tracts are spared!
Pernicious anemia - which antibody is most specific for it?
Anti-parietal cell antibodies
Causes of macrocytic anaemia
Megaloblastic: B12 and folate def
Non-megalo: RALPH =reticulocytes, alcohol, liver failure, pregnancy, hypothyroid
Other haem probs: aplastic anaemia/MDS/MPS
