Hemolytic Anemia

Question 1

Clinical symptoms of hemolytic anemia

Answer 1

Clinical Features (Symptoms and Signs)
Pallor: The patient may look pale, especially in the mucous membranes (inside of the mouth, eyes, etc.).

Jaundice: Mild, fluctuating yellowing of the skin and eyes due to increased breakdown of red blood cells.

Splenomegaly: The spleen (an organ involved in filtering blood) may be enlarged.

Urine Changes: There’s no bilirubin (a yellow compound) in the urine, but it may turn dark after standing due to excess urobilinogen, which turns into highly colored urobilin when exposed to light.

Gallstones: Pigment (bilirubin) gallstones can form as a complication.

Question 2

What’s aplastic crisis?
And it’s signs

Answer 2

Aplastic Crises

These are sudden worsening episodes of anemia, usually triggered by an infection with parvovirus, which temporarily stops red blood cell production. Signs of an aplastic crisis include:

A sudden drop in the number of red blood cells

A decrease in reticulocyte count (young red blood cells)

Question 3

Laboratory signs of hemolytic anemia

Answer 3

Features of Increased Red Cell Breakdown

These findings indicate that red blood cells are being destroyed faster than normal.

Serum Bilirubin Raised: Bilirubin levels in the blood are higher than normal. This bilirubin is unconjugated (not yet processed by the liver) and bound to a protein called albumin.

Urine Urobilinogen Increased: The levels of urobilinogen in the urine are higher. Urobilinogen is a product of bilirubin breakdown.

Serum Haptoglobins Absent: Haptoglobins, proteins that bind to hemoglobin released from destroyed red blood cells, are absent. This is because they become saturated with hemoglobin and are then removed from the bloodstream by certain cells in the immune system (RE cells).

2. Features of Increased Red Cell Production

These findings show that the body is trying to compensate for the increased destruction of red blood cells by producing more.

Reticulocytosis: There is an increased number of reticulocytes (immature red blood cells) in the blood. This indicates that the bone marrow is producing more red blood cells to replace the ones being destroyed.

Bone Marrow Erythroid Hyperplasia: The bone marrow shows an increased number of red blood cell precursors. Normally, the ratio of myeloid cells (another type of blood cell) to erythroid cells (red blood cell precursors) is between 2:1 and 12:1. In hemolytic anemia, this ratio is reduced to 1:1 or even reversed, indicating more red blood cell production.

3. Damaged Red Cells, Visualized by:

These findings show the physical signs of red blood cell damage.

Routine Blood Film Morphology: Under a microscope, damaged red blood cells can be seen. These may include:

Microspherocytes: Small, round red blood cells.

Elliptocytes: Elliptical or oval-shaped red blood cells.

Fragments: Pieces of red blood cells.

Flow Cytometry after Eosin-Maleimide (EMA) Staining: This is a lab test that uses a special dye (EMA) to stain red blood cells. Flow cytometry then analyzes these cells to detect abnormalities.

Specific Enzyme, Protein, or DNA Tests: These tests check for specific defects in enzymes, proteins, or DNA that could be causing the hemolytic anemia.

Question 4

What are the Main Laboratory Features of Intravascular Hemolysis

Answer 4

Haemoglobinaemia and Haemoglobinuria:

Haemoglobinaemia: Presence of free hemoglobin in the blood.

Haemoglobinuria: Presence of hemoglobin in the urine, indicating that the kidneys are filtering out excess hemoglobin.

Haemosiderinuria: Presence of haemosiderin (an iron-storage complex) in the urine, resulting from the breakdown of hemoglobin in the kidneys.

Methaemalbuminaemia: Formation of methaemalbumin, which is detected in the blood using a spectrophotometer.