Haemolysis - Causes + Ix

Question 1

The haemolysis can be ?, or extravascular (reticuloendothelial system of the ?, ? and ??).

This may be asymptomatic, but haemolytic anaemia then develops if the ? ? does not sufficiently compensate.

Answer 1

intravascular 
liver
spleen
BM
BM

Question 2

Intrinsic Causes;

0 Haemaglobinopathies: ? Cell / ?.
0 Membranopathies: ? / Eliptocytosis.
0 Enzymeopathies: ? deficiency

Answer 2

sickle
thalassaemia
spherocytosis
G6P

Question 3

Extrinsic Causes;

o ? disease: warm or cold.
o Alloimmune disease: ?/? reaction, ?disease.
o Drug induced: e.g. ?.
o ?: plasmodium etc.
o Microangiopathic haemolytic anaemias: e.g. ?.

Answer 3

autoimmune
transplant/transfusion
rhesus
penicillins
parasites
DIC

Question 4

Investigations

Signs suggestive increased RBC breakdown;

• –Anaemia with ? MCV.
• –Raised bilirubin: ?, pre-hepatic ?.
• –Raised serum ?: released from RBCs.

Signs suggestive of increased RBC production;

• –Reticulocyte Count: >?% or 100 x109 /L:
• > will give a ? MCV.

Answer 4

raised
unconjugated
jaundice
LDH
2
raised

Question 5

Ix
A blood film can then often give clues as to the ‘cause’;

• –Hypochromic, microcytic cells: ?.
• –? cells: SCA.
• –?: hereditary ?, or autoimmune haemolytic anaemia.
• –Eliptocytes: hereditary ?.
• –Heinz bodies/ ‘?’ cells: ? deficiency.
• –?: microangiopathic haemolytic anaemia.

Answer 5

thalassaemia
sickle
spherocytes
spherocytosis
eliptocytosis
bite
g6PD
schistocytes

Question 6

Further tests;

Coomb’s test (DAT);
o Identifies RBCs coated with ? or ? , indicating an ? cause of haemolysis.

Hb electrophoresis;
o Can identify different ?.

Answer 6

ab’s
complement
immune
haemoglobinopathies

Question 7

Further tests

? assays;
—o If other causes have been excluded.

Plasma ? (reduced) and urinary ? (present);
—o Indicate ? haemolysis: ? usually ‘mops up’ free plasma Hb in the circulation, and prevents free Hb being filtered by the ?.

Answer 7

enzyme
haptoglobin
haemosiderin
intravascular
haptoglobin
glomeruli