HAEMOLYTIC ANEMIA

Question 0

History features?

Answer 0

Pallor of rapid onset
Jaundice, pre-hepatic
Gallstone: pigmented gallstones dt bilirubin
FHx

Question 1

Causes of haemolysis?

Answer 1

Hereditary (intravascular)

• abnormal haemoglobin synthesis
• abnormal enzymes G6PD
• abnormal membrane defects (spherocytosis)

Acquired

• IMMUNE
  - Haemolytic transfusion reactions, autoimmune HA (AIHA), drugs (penicillin), cold agglutination
• NON-IMMUNE
  - MAHA: thrombus in BV causes shearing of RBCs e.g. DIC, HUS/TTP, pre-eclampsia/HELLP, vasculitides
  - infection (malaria
  - hypersplenism

Question 2

Exam findings?

Answer 2

Spleenomegaly

Anaemia

Question 3

Ix?

Answer 3

CBE - Hb and MCV
Peripheral blood smear
- spherocytes (haemolysis damaging shape)
- schistocytes (fragmented RBC),

Diagnose with
- increases LDH and decreases haptoglobin

Reticulocyte count
If autoimmune DAT test will be +ve
Bilirubin unconjugated

Question 4

Classical investigation findings of HA?

Answer 4

Raised LDH, reticulocytes, unconjugated bilirubin, urobilinogen

Decreased haptoglobin