Haemolysis Flashcards
What is compensated haemolysis?
Increased red cell destruction compensated by increased red cell production
i.e. Hb maintained
What is haemolytic anaemia?
(haemolytic anaemia - decompensated anaemia)
-increased rate of red cell destruction exceeding bone marrow capacity for red cell production i.e. Hb falls
Do reticulocytes have nuclei?
NO !!! They are not nucleated cells !!!
What is polychromasia?
Disorder where there is an abnormally high number of red blood cells found in the bloodstream as a result of being prematurely released from the bone marrow during formation
How do you stain reticulocytes?
Use methylene blue
-RIBSOMAL RNA WILL SHOW UP
Difference between extravascular and intravascular haemolysis?
Extravascular - cells taken up by spleen and liver etc
Intravascular - cells destroyed in the circulation
Warm IgG autoantibodies
- Idiopathic (commonest)
- autoimmune disorders (SLE)
- lymphoproliferative disorders (CLL)
- drugs (penicillins etc)
- infections
Cold IgM autoantibodies
- idiopathic
- infections (EBV, mycoplasma)
- lymphoproliferative disorders
Discuss the antibodies produced in alloimmune haemolysis
Haemolytic transfusion reaction
- Immediate (IgM) predominantly intravascular
- Delayed (IgG) predominantly extravascular
What type of haemolysis would you see in a leaky heart valve?
Microangiopathic haemolytic anaemia (or MAHA) for short
-this is red cell fragmentation as a result of mechanical damage
When might you see microspherocytes?
These are only seen in severe burns! (red cells are sheared as they pass through damaged capillaries)
Membrane defects that could cause haemolysis?
- liver disease (zieve’s syndrome)
- vitamin E deficiency
- paroxysmal nocturnal haemoglobinuria
What is Zieve’s syndrome and what cells would you see?
An acute metabolic condition that can result from withdrawal from prolonged alcohol abuse
- you would see SPUR CELLS and ACANTHOCYTES
- polychromatic macrocytes
- also see HYPERLIPIDEMIA !!!!
Hyperlipidemia
Polychromatic macrocytes
Spur cells
Acanthocytes
Zieve’s syndrome
What is the definition of haemolysis?
Premature red cell destruction (NOT shortened red cell survival)
What is it about the spleen that causes extravascular red cell destruction?
The oxidant environment in the spleen causes extravascular red cell destruction
Name 2 drugs which could cause haemolysis due to oxidative damage
- dapsone
- salazopyrin
If dapsone causes haemolysis, what would you see on blood film?
Keratocyte and irregularly contracted cell
What type of mutation causes sickle cell disease?
Caused by a POINT MUTATION in beta globin chain
What are pappenheimer bodies and which condition would you find them in?
Pappenheimer bodies are abnormal granules of iron found in the blood cells
-seen in beta thalassaemia major
Blood film findings of beta thalassaemia major
- target cells
- nucleated cells (NOT normal in blood!!)
- pappenheimer bodies
- alpha chain precipitates
Marrow findings in beta thalassaemia major
Erythroid hyperplasia
What happens to the gallbladder in anaemia?
Get gallstones! (bilirubin stones) –> relfect the patients lifelong haemolytic state
Hereditary spherocytosis inheritance?
Dominant inheritance
