Haemolysis Flashcards

1
Q

what is haemolysis?

A

the premature destruction of red cells

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2
Q

what is compensated haemolysis?

A

increased red cell destruction that is compensated for by increased red cell producction

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3
Q

what happens to the Hb level in compensated haemolysis?

A

it is maintained so the patient won’t become anaemic

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4
Q

what is another name for haemolytic anaemia?

A

decompensated haemolysis

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5
Q

what is haemolytic anaemia?

A

increased rate of red cell destruction that exceeds the bone marrows capacity for red cell production

causes a fall in Hb

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6
Q

what are the two main consequences of haemolysis?

A

erythroid hyperplasia

excess RBC breakdown products

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7
Q

what is erythroid hyperplasia?

A

increased bone marrow RBC production

the appropriate response to reduced RBC levels

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8
Q

what is the appropriate bone marrow response to haemolysis and how is this achieved?

A

increase RBC production

via reticulocytosis and erythroid hyperplasia

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9
Q

what are the two types of haemolysis based on where the haemolysis occcurs?

A

extravascular

intravascular

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10
Q

what happens in extravascular haemolysis?

A

RBCs are taken up by the reticuloendothelial system - mainly the spleen and liver

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11
Q

what type of haemolysis is more common - intra or extra vascular?

A

extravascular

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12
Q

what organ changes can be seen in extravascular haemolysis?

A

splenomegaly

hepatomegaly

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13
Q

what is RBC product is released in extravascular haemolysis?

A

protoporphyrin

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14
Q

what findings would be seen in extravascular haemolysis?

A

unconjugated bilirubinaemia

urobilinogenuria

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15
Q

what are two possible consequences of high bilirubin levels in extravascular haemolysis?

A

jaundice

gallstones

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16
Q

what happens in intravascular haemolysis?

A

red cells are destroyed within the circulation, causing their contents to spill into the blood

17
Q

what four findings are seen in intravascular haemolysis?

A

haemoglobinaemia
methaemalbuminaemia
haemoglobinuria
haemosiderinuria

18
Q

what is haemoglobinaemia?

A

free Hb in the circulation

19
Q

what is methaemalbuminaemia?

A

free haem joining with albumin in the blood

20
Q

what colour is urine in haemoglobinuria?

A

pink

turns black when left to stand

21
Q

name some possible causes of intravascular haemolysis

A

ABO incompatibility
G6PD deficiency
severe falciparum malaria

22
Q

what tests should be done to confirm that a patient is in a haemolytic state?

A
FBC + blood film 
reticulocyte count 
serum unconjugated bilirubin 
serum haptoglobins
urinary urobilinogen
23
Q

what finding on blood film is suggestive of RBC membrane damage?

A

spherocytes

24
Q

what finding on blood film is suggestive or RBC mechanical damage?

A

red cell fragments

25
what finding on blood film is suggestive of RBC oxidative damage?
heinz bodies
26
what does the direct coomb's test do?
identifies antibodies bound to red cells
27
what are some possible causes of premature destruction of red cells?
autoimmune haemolysis | mechanical destruction
28
what is the "warm" autoantibody in autoimmune haemolysis?
IgG
29
name some causes of autoimmune haemolysis with IgG autoantibodies present
idiopathic SLE lymphoproliferative disorders
30
what is the "cold" autoantibody in autoimmune haemolysis?
IgM
31
name some causes of autoimmune haemolysis with IgM autoantibodies
idiopathic | infections
32
name some possible causes of mechanical red cell destruction
``` DICC HUS leaky heart avalves infections burns ```
33
what type of anaemia can be caused by a leaking heart valve?
microangiopathic haemolytic anaemia (MAHA)
34
what are some possible acquired causes of an abnormal RBC membrane?
liver disease vit E deficiency PNH