Haemolytic anaemia Flashcards
What are the three main things you can see on investigations that occur because of red cell breakdown?
^ Bilirubin (unconjugated)
^ urinary urobilinogen
^ Serum LDH (released from RBC)
How can you tell is extravascular haemolysis is most likely to be occurring?
Splenomegaly
How can you tell is intravascular haemolysis is most likely to be occurring?
^Free plasma Hb
Decrease in plasma haptoglobin
^Methaemalbuminaemia (Free Hb is broken down, and the haem binds to albumin)
Haemoglobinuria (red-brown urine)
How do you divide causes of haemolytic anaemia?
Acquired
Hereditary
How do you divide the acquired causes of haemolytic anaemia?
Immune/non-immune (or Coombs +ve/Coombs -ve)
How do you divide the Hereditary causes of HA?
Haemoglobinopathies
Enzymopathies
Membranopathies
Heinz bodies and bite cells are seen in which type of anaemia?
G6PD Deficiency
Schistocytes are seen in what condition causing HA?
MAHA - Microangiopathic haemolytic anaemia
What test is used to confirm spherocytosis?
Osmotic fragility test
Name 2 causes of MAHA
Mechanical heart valves
Marching
What two things can precipitate oxidative crises in G6PD deficiency pts?
Exposure to broad/fava beans
Henna
What can exacerbate haemolysis?
Infections - especially with parvoviruses - can lead to aplastic crisis
Treatment for spherocytosis?
Splenectomy
Treatment for thalassaemia?
Frequent transfusions
Treatment for sickle cell?
Avoid precipitants, Folic acid, penicillin and vaccinations (transfusions not often given)
Treament for G6PD deficiency?
Avoid precipitants, transfuse if necessary
Treatment for warm AIHA?
Prednisolone
+/- splenectomy
Treatment for cold AIHA
Avoid cold, treat underlying condition
Treatment for PNH?
Supportive, Eculizumab
What 4 things may a pt with HA present with?
Jaundice
Hepatosplenomegaly
Gallstones (due to ^bilirubin in haemolysis)
Leg ulcers (poor blood flow to LL)
What 8 investigations would you run for suspected HA?
FBC, reticulocytes, bilirubin, LDH, haptoglobin, urinary urobilinogen, thick and thin films for malaria if travel Hx, blood film
Pt presents with ?HA, on blood film they show hypochromic microcytic cells, Dx?
Thalassaemia
Pt presents with ?HA, on blood film they show shistocytes, Dx?
MAHA
Pt presents with ?HA, on blood film they show Heinz bodies, Dx?
G6PD Deficiency
Pt presents with ?HA, on blood film they show abnormal cells, Dx?
Malignancy
