Haemolysis

Question 1

What is compensated haemolysis?

Answer 1

Increased red cell destruction compensated by increased red cell production
i.e. Hb maintained

Question 2

What is haemolytic anaemia?

Answer 2

(haemolytic anaemia - decompensated anaemia)

-increased rate of red cell destruction exceeding bone marrow capacity for red cell production i.e. Hb falls

Question 3

Do reticulocytes have nuclei?

Answer 3

NO !!! They are not nucleated cells !!!

Question 4

What is polychromasia?

Answer 4

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

Question 5

How do you stain reticulocytes?

Answer 5

Use methylene blue

-RIBSOMAL RNA WILL SHOW UP

Question 6

Difference between extravascular and intravascular haemolysis?

Answer 6

Extravascular - cells taken up by spleen and liver etc

Intravascular - cells destroyed in the circulation

Question 7

Warm IgG autoantibodies

Answer 7

• Idiopathic (commonest)
• autoimmune disorders (SLE)
• lymphoproliferative disorders (CLL)
• drugs (penicillins etc)
• infections

Question 8

Cold IgM autoantibodies

Answer 8

• idiopathic
• infections (EBV, mycoplasma)
• lymphoproliferative disorders

Question 9

Discuss the antibodies produced in alloimmune haemolysis

Answer 9

Haemolytic transfusion reaction

• Immediate (IgM) predominantly intravascular
• Delayed (IgG) predominantly extravascular

Question 10

What type of haemolysis would you see in a leaky heart valve?

Answer 10

Microangiopathic haemolytic anaemia (or MAHA) for short

-this is red cell fragmentation as a result of mechanical damage

Question 11

When might you see microspherocytes?

Answer 11

These are only seen in severe burns! (red cells are sheared as they pass through damaged capillaries)

Question 12

Membrane defects that could cause haemolysis?

Answer 12

• liver disease (zieve’s syndrome)
• vitamin E deficiency
• paroxysmal nocturnal haemoglobinuria

Question 13

What is Zieve’s syndrome and what cells would you see?

Answer 13

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 !!!!

Question 14

Hyperlipidemia
Polychromatic macrocytes
Spur cells
Acanthocytes

Answer 14

Zieve’s syndrome

Question 15

What is the definition of haemolysis?

Answer 15

Premature red cell destruction (NOT shortened red cell survival)

Question 16

What is it about the spleen that causes extravascular red cell destruction?

Answer 16

The oxidant environment in the spleen causes extravascular red cell destruction

Question 17

Name 2 drugs which could cause haemolysis due to oxidative damage

Answer 17

• dapsone

- salazopyrin

Question 18

If dapsone causes haemolysis, what would you see on blood film?

Answer 18

Keratocyte and irregularly contracted cell

Question 19

What type of mutation causes sickle cell disease?

Answer 19

Caused by a POINT MUTATION in beta globin chain

Question 20

What are pappenheimer bodies and which condition would you find them in?

Answer 20

Pappenheimer bodies are abnormal granules of iron found in the blood cells
-seen in beta thalassaemia major

Question 21

Blood film findings of beta thalassaemia major

Answer 21

• target cells
• nucleated cells (NOT normal in blood!!)
• pappenheimer bodies
• alpha chain precipitates

Question 22

Marrow findings in beta thalassaemia major

Answer 22

Erythroid hyperplasia

Question 23

What happens to the gallbladder in anaemia?

Answer 23

Get gallstones! (bilirubin stones) –> relfect the patients lifelong haemolytic state

Question 24

Hereditary spherocytosis inheritance?

Answer 24

Dominant inheritance

Question 25

What type of haemolysis in hereditary spherocytosis (intravascular vs extravascular)

Answer 25

Extravascular

Question 26

Golf ball cells

Answer 26

HbH