Hemolytic Anemia Flashcards
intravascular hemolysis
RBC ruptures in circulation
extravascular hemolysis
RBC rupture happens outside of circulation
most commonly in the spleen
How is heme degraded?
broken down in spleen to biliverdin and unconjugated bilirubin
*unconjugated bilirubin then goes to liver
haptoglobin in intra/extravascular hemolysis
intra: decreased because haptoglobin binds to free heme sites
extra: normal
LDH in intra/extravascular hemolysis
may be elevated in both
indirect bilirubin in intra/extravascular hemolysis
unconjugated bilirubin can be elevated in both
see more elevation in extravascular hemolysis
why does intravascular hemolysis not contributed to indirect bilirubin as much?
only small amounts of heme bound to haptoglobin will be recycled to bilirubin
Hepatosplenomegaly and lymphadenopathy indicate …
extravascular hemolysis
Urine dip for heme in intra/extravascular hemolysis
intra: positive for heme in urine
extra: no
urine dip for RBC in intra/extravascular hemolysis
usually negative in all hemolysis
DAT / direct coombs
indicates if hemolysis is immune-mediated or not
DAT vs. IAT
DAT tests immunoglobin or complement directly on RBC
IAT tests for red cell antibodies in patient’s serum
warm immune hemolytic anemia
+DAT
IgG mediated
most complete treatment is splenectomy
what can acute spherocytes indicate?
acute hemolytic anemia
not hereditary
hereditary spherocytosis vs. autoimmune anemia
look at DAT / coombs test
hereditary spherocytosis
spherocytes cannot traverse through spleen sinusoids in times of inflammation
RBCs are damaged in the spleen
leads to RBC breakdown / anemia
Inheritance pattern of G6PD def.
X-linked
Pathophysiology of G6PD Def.
pentose phosphate shunt cannot regenerate NADPH which is needed for formation of glutathionine
therefore, cannot overcome oxidative challenges
Is hereditary spherocytosis intra or extravascular?
extravascular
is autoimmune hemolysis intravascular or extravascular?
IgG = extravascular
IgM = intravascular
is G6PD def. intra or extravascular?
mostly intravascular
is sickle cell intra or extravascular?
both
is a-thalassemia intra or extravascular?
seems to be more extravascular
definitely intramedullary
what symptom is associated with elevated bilirubin?
jaundice
what can a hypersegmented neutrophil indicate?
folate def. or B12 def
how can you differentiate between B12 and folate def?
only B12 def presents with neuro symptoms
list 5 hypoproliferative anemias
anemia of inflammation
B12 + folate def
lead toxicity
aplastic anemia
iron deficiency anemia
what indicates a hypoproliferative anemia?
low retic
Hemochromatosis
iron overload
how can you determine between iron def. anemia and anemia of inflammation?
anemia of inflammation will have LOW TIBC (don’t want iron)
iron def. anemia will have high TIBC (trying to bind the little amounts of iron)
what is similar about anemia of inflammation and iron deficiency anemia
both have low Fe
anemia of inflammation has low Fe to limit iron in blood
when is ferritin low
iron deficiency anemia
percent iron saturation in iron def. anemia
low
TIBC stands for
total iron binding capacity
Hemoccult
tells you if you have blood in stool
indicates bleeding somewhere in GI tract
megaloblastic anemia
very large red blood cells
decrease in the number of RBCs
difference between megaloblastic anemia and macrocytic anemia
megaloblastic anemia is a type of macrocytic anemia
megaloblastic anemia occurs during B12 def.
lead toxicity leads to …
hypoproliferative anemia
elevated platelet indicates …
inflammation
how can you treat immune-mediated hemolysis?
steroid
steroids are quick acting immunosuppressants
Spherocytes with agglutination are seen in …
autoimmune hemolytic anemia
uniform spherocytes are seen in …
hereditary spherocytosis
heinz bodies and bite cells are seen in ….
G6PD def
schistostocytes are seen in
HUS
basophilic stippling is seen in
iron deficiency and lead toxicity
How do you calculate ANC?
WBC * (neutrophil% + band%)
How do you calculate ALC?
WBC * leukocyte%
How can you determine neutropenia?
calculate the ANC
List lab values for mild, moderate and high-risk neutropenia
mild: <750 ANC (cell/mm)
moderate: < 500 ANC (cell/mm)
high: <100 ANC (cells/mm)
leukocytosis
HIGH white blood cell count
indicates immune response (secondary cause)
can indicate leukemia (primary cause)
leukopenia
LOW white blood cell count
can be caused by aplastic anemia
can also be caused by chemotherapy and other things
aplastic anemia
cannot produce enough new blood cells
What happens at ANC < 750?
risk for bacterial infection rises
Bloody diarrhea can be associated with which type of anemia?
HUS
mediated by shiga-like toxin
bone marrow of aplastic anemia
acellular bone marrow
Difference between ITP and aplastic anemia
in ITP only platelet count is low
in aplastic anemia, everything is low
what is the only treatment for Fanconi anemia?
stem cell transplant
4 categories of pantocytopenia
1) loss of stem cells (fanconi, DNA damage, autoimmune)
2) marrow replacement
3) bone marrow suppression
4) peripheral destruction of cells
What can cause bone marrow replacement?
mylofibrosis or cancer like leukemia
What can cause loss of stem cells?
Fanconi, autoimmune disorder, or acquired expsoure
what can cause bone marrow suppression?
drugs or viruses
