Immuno-Hemolytic anemia

Question 1

Antibodies against person’s own red blood cells cause lysis leading to anemia

Answer 1

Autoimmune hemolytic anemia (AIHA)

Question 2

Warm AIHA secondary to: 3 things

Answer 2

1) Lymphoproliferative disorders (Hodgkin Lymphoma)
2) Some rheumatic disorders (SLE)
3) Some non-lymphoid malignancies

Question 3

Cold agglutinins secondary to:2 things

Answer 3

Mycoplasma pneumoniae infection or B cell malignancies

Question 4

Mycoplasma pneumoniae infection

Answer 4

Cold agglutinins secondary cause

Question 5

Cold AIHA has two types

Answer 5

Cold agglutinins

Cold Hemolysins

Question 6

Cold agglutinins vs.
Cold Hemolysins
Compare and contrast

Answer 6

Both are COLD AIHA; both may be primary or idiopathic;

Cold agglutinins secondary to Mycoplasma pneumoniae infection or B cell malignancies;
Cold hemolysins secondary to Paroxysmal Cold Hemoglobinuria

Question 7

Drug-induced hemolytic anemia (DIHA) causes:

Answer 7

• Penicillins
• Cephalosporins
• Levodopa and methyldopa
• NSAIDs

Question 8

> 60% of infectious mono patients (exposed to EBV) suffer from:

Answer 8

COLD agglutinins type of Cold AIHA

Question 9

May be aggravated or present at pregnancy

Answer 9

Warm AIHA syptoms

Question 10

Chronic anemia ± jaundice

Answer 10

Cold AIHA symptoms

Question 11

Periodic, acute hemolysis with hemoglobinuria induced by chilling

Answer 11

Cold AIHA symptoms

Question 12

Warm AIHA: DAT test positive for:

Answer 12

anti-IgG, anti-C3, or both

Question 13

COLD AIHA: DAT test positive for:

Answer 13

DAT negative for anti-IgG; positive for anti-C3

Question 14

Draw the pts serum for 1)

Draw the pts WHOLE blood for 2)

Answer 14

1) INDIRECT coombs

2) DIRECT coombs

Question 15

Positive test shows Antibodies are shown attached to antigens on the RBC surface;

Answer 15

DAT; direct coombs test;

Question 16

AIHA–> IgG only OR IgG and Complement

Answer 16

Warm AIHA

Question 17

AIHA–> Complement only; NO IgG;

Answer 17

Cold AIHA

Question 18

Pathogenesis of ____:
B-cell is activated and secretes IgG and IgM;

• IgG does two things:
  1) binds to RBC which activates Classical Complement Pathway; these complement fixed RBCs are phagocytosed by splenic macrophages;

2) complement fixation leading to MAC attack causing intravascular RBC lysis;
- IgM binds to RBCs leads to agglutination and formation of immune complex (antigen-antibody) complex and causes lysis (type III hypersenitivity)

Answer 18

AIHA; see image in lecture

Question 19

pathogenesis of AIHA:

1) is activated and secretes 2)

Answer 19

1) B-cell

2) IgG and IgM

Question 20

pathogenesis of AIHA:

IgG secreted from B-cell does:

Answer 20

binds to RBC and activates Class. compliment; these RBCs are then phagocytosed by splenic macrophages

Question 21

pathogenesis of AIHA:

how does INTRAvascular RBC lysis occur?

Answer 21

Through complement fixation leading to MAC attack;

Question 22

pathogenesis of AIHA:

what does IgM secreted from B-cell do?

Answer 22

-IgM binds to RBCs leads to agglutination and formation of immune complex (antigen-antibody) complex and causes lysis (type III hypersenitivity)

Question 23

small molecule generates an immune response when attached to a larger molecule

Answer 23

Hapten mechanism (DIHA)

Question 24

Helps the larger molecule elicit an immune response

Answer 24

Hapten mechanism (DIHA)

Question 25

penicillins use 1) mechanism to cause

DIHA

Answer 25

1) hapten

Question 26

Autoantibody mechanism of DIHA

Drug stimulates 1) against 2)

Answer 26

1) IgG production

2) RBCs

Question 27

Immune complex mechanism of DIHA:

Drug stimulates 1) against RBCs, which leads to immune complex formation and complement activation

Answer 27

IgM production

Question 28

direct coomb’s positive for IgG only; what mechanism caused the DIHA?

Answer 28

hapten drug adsorption type or autoantibody type

Question 29

Direct Coomb’s positive for COMPLEMENT only; what mechanism caused the DIHA?

Answer 29

Immune complex mechanism aka ternary complex type: IgM production against RBCs, which leads to immune complex formation and complement activation

Question 30

DIHA:

Ig production: Immune complex mechanism, autoantibody mechanism, hapten mechanism

Answer 30

IgM for Immune complex type
IgG for autoantibody and hapten;
Both are against RBCs, obviously

Question 31

Mild to moderate hemolysis, with slow onset developing over days to weeks

Answer 31

DIHA symptoms due to:
Penicillin
Methyldopa

Question 32

Sudden, severe hemolysis with hemoglobinuria

Answer 32

DIHA symptoms due to:

Ceohalosporin

Question 33

DIHA symptoms due to:

Cephalosporin vs. Penicililn or methyldopa

Answer 33

Penicililn or methyldopa–> mild hemolysis slow onset over days or weeks;
Cephalosporin–> sudden, severe hemolysis