Haemolytic Anaemia Flashcards
Define Haemolytic Anaemia?
Premature erythocyte breakdown causing shortened erythocyte life span (<120 days) with anaemia
What is the hereditary aetiology of Haemolytic Anaemia?
Membrane Defects
Metabolic Defects
Haemoglobinopathies
What Membrane Defects can cause Haemolytic Anaemia?
Hereditary spherocytosis
Elliptocytosis
What Metabolic Defects can cause Haemolytic Anaemia?
G6PD deficiency
Pyruvate Kinase Deficiency
What haemoglobinopathies can cause Haemolytic Anaemia?
Sickle cell disease
Thalassemia
What is the Acquired aetiology of Haemolytic Anaemia?
Autoimmune Isoimmune Drugs Trauma Infection Paroxysmal Nocturnal Haemoglobinuria
What is the Autoimmune cause of Haemolytic Anaemia?
Antibodies attach to erythocytes causing intravasular and extravascular haemolysis
What are the Isoimmune causes of Haemolytic Anaemia?
Transfusion reaction
Haemolytic disease of the newborn
What drugs can caused Haemolytic Anaemia?
Penicillin
Quinine
Why do some drugs cause Haemolytic Anaemia?
Caused by the formation of a drug-antibody-erythocyte complex
What are the Trauma causes of Haemolytic Anaemia?
Microangiopathic Haemolytic Anaemia (caused by RBC fragmentation in abnormal microcirculation)
E.g. haemolytic uraemic syndrome, DIC, malignant hypertension
What are the Infective causes of Haemolytic Anaemia?
Malaria
Sepsis
What is the epidemiology of Haemolytic Anaemia?
COMMON
Genetic causes are prevalent if African, Mediterranean and Middle Eastern populations
Hereditary spherocytosis is the most common inherited haemolytic anaemia in northern Europe
What are the presenting symptoms of Haemolytic Anaemia?
Jaundice
Haematuria
Anaemia
What are the signs of Haemolytic Anaemia on physical examination?
Pallor
Jaundice
Hepatosplenomegaly
What investigations would you do for Haemolytic Anaemia?
Bloods Blood Film Urine Direct Coombs' Test Osmotic fragility test or Spectrin mutation analysis Ham's Test Hb Electrophoresis or Enzyme Assays Bone Marrow Biopsy (Rarely Performed)
What bloods do you do for Haemolytic Anaemia?
FBC
U&Es
Folate
What do you look for specifically on a FBC for Haemolytic Anaemia?
Low Hb High reticulocytes High MCV High unconjugated bilirubin Low haptoglobin (a protein that binds to free Hb released by RBCs)
What might we see on a blood film for Haemolytic Anaemia?
Leucoerythroblastic picture
Macrocytosis
Nucleated erythrocytes or reticulocytes
Polychromasia
What specific abnormal cells do you see on a Blood Film for Haemolytic Anaemia?
Spherocytes Elliptocytes Sickle cells Schistocytes Malarial parasites
What do we see on Urinalysis for Haemolytic Anaemia?
High urobilinogen
Haemoglobinuria
Haemosiderinuria
What is the Direct Coombs’ Test?
Tests for autoimmune haemolytic anaemia
Identifies erythocytes coated with antibodies
How do we use Osmotic Fragility Test for Haemolytic Anaemia?
Identifies membrane abnormalities
What is the Ham’s Test for Haemolytic Anaemia?
Lysis of erythocytes in acidified serum in paroxysmal nocturnal haemoglobinuria
Why do we do a Hb Electrophoresis or Enzyme Assays for Haemolytic Anaemia?
To exclude other causes
