Haemolytic Anaemia

Question 1

Haemolytic Anaemia Pathogenesis

Answer 1

• Normal red cells have lifespan of 120 days, can be shorter in haemolytic anaemias
• Haemolysis can occur by two mechanisms
• Intravascular: due to complement fixation, trauma, or other extrinsic factors. Examples are prosthetic cardiac valves, G6PD deficiency, DIC
• Extravascular (most common): red cells removed by mononuclear-phagocytic system because intrinsically defective or bound immunoglobulins

Question 2

Haemolytic Anaemia Aetiology

Answer 2

Genetic
-Membrane abnormalities, haemoglobin abnormalities, enzyme defects
Acquired
-Immune (HDFN, blood transfusion reaction)
-Autoimmune (warm antibody type, cold antibody type)
-Non immune (trauma, infection, liver disease)

Question 3

Haemolytic Anaemia Presentation

Answer 3

Symptoms
-Both anaemia and underlying disorder
-Billirubin stones can develop
-Haemoglobinuria can develop in haemolysis and produce dark urine 
Signs
-Anaemia
-Mild jaundice
-Splenomegaly
-Leg ulcers (sickle)

Question 4

Haemolytic Anaemia Ix

Answer 4

• FBC
• Reticulocytes
• Smear
• LFTs (bilirubin)
• LDH and haptoglobin (increased LDH and reduced haptoglobin is very specific for haemolysis)
• Urinalysis
• Coombs (if positive, immune, cold vs warm)

Question 5

Haemolytic Anaemia Management

Answer 5

• Remove cause
• Folic acid
• Steroids if immune mediated
• Consult haematology