Hemolytic Anemia

Question 1

What are the lab markers for intravascular hemolytic anemia?

Answer 1

decrease in free haptoglobin

LDH increases

Question 2

What are the lab markers for extravascular hemolytic anemia?

Answer 2

increase in indirect bilirubin

increase in LDH

Question 3

What’s the deal with cold agglutinins?

Answer 3

IgM (cold weather is Miserable)
occurs w/ EBV or mycoplasma
occurs w/ malignancies, such as CLL
**problem comes when there is circulation to a cold extremity

Question 4

What’s the deal with warm agglutinins?

Answer 4

IgG (warm weather is great)
react against RBC protein antigens at body temp
Seen iN:
EBV, HIV
Lupus
Malignancies: CLL, B cell lymphoma
Congenital Immune abnormalities

Question 5

Describe a direct coombs test?

Answer 5

give patient antibodies that will bind their antibodies (already bound to RBCs) and cause agglutination

seen in hemolytic disease of newborn
drug-induced autoimmune hemolytic anemia
hemolytic transfusion reactions

Question 6

Describe an indirect coombs test?

Answer 6

patient’s serum given normal RBCs. if agglutinate b/c patient has free floating antibodies–>+

Question 7

What is the treatment for paroxysmal nocturnal hemoglobinuria?

Answer 7

terminal complement inhibitor

eculizumab

Question 8

Crew cut skull on X-ray is indicative of what?

Answer 8

thalassemias

sickle cell anemia

Question 9

What is the treatment for sickle cell anemia?

Answer 9

hydroxyurea, increases hbF

Question 10

What are some complications of sickle cell disease?

Answer 10

aplastic crisis w/ parvovirus B19 infection
salmonella osteomyelitis
autosplenectomy–>then howell jolly bodies b/c spleen can’t get rid of them
w/o spleen–>increased risk for encapsulated organisms
splenic infarct/sequestration crisis
painful crises of vaso occlusion like dactylitis and avascular necrosis
renal papillary necrosis