intro to hemolytic anemias Flashcards
classification of anemias
secondary to blood loss Accelerated destruction (hemolytic anemias) Decreased production (hypoproliferative)
hemolytic anemia
RBC destruction resulting in loss of red cell mass, release of cellular contents
Intrinsic (primary RBC problem)- RBC membrane disorder, RBC enzyme deficiency, hemoglobinopathies
Extrinsic- problem which affects RBC survival- autoimmune, mechanical trauma, infection, chemical injury, splenic sequestration
Red cell destruction (shortened RBC lifespan)–> compensatory increased in erythropoiesis –> Hb degradation products secondary to hemolysis (hemosiderosis, hyper bilirubinemia, pigmented gallstones
types of pathologci hemolysis
extravascular (common), spleen»»>liver and bone marrow, Macrophage mediated (antibody mediated
Intravascular less common, within the vessels, complement, mechanical vascular infection
Could be both
Lab evaluation of hemolysis of blood
CBC many times is normocytic to macrocytic anemia, reticulocytosis (common to all hemolytic anemia)
biochemistry- release of cell components including (LDH) AST and potassium Hyper bilirubinemia (secondary to heme catabolism , unconjugated bilirubinemia,
Hb emia (free hb in plasma, morepronounces in intravascular hemolysis), haptoglobin binds free Hgb (decreased haptoglobin)
DAT (direct antiglobin test)
hemolysis in urine
hemoglobinuria- intravascular process, positive dipstick in the absence of RBC, increased urobilinogen in urine, (breakdoen product of biliveridin in the gut and reabsorbed and excreted in urine
hemosidernuria (intravascular process, iron storage deposits in renal epithelium then shed in urine
clinical features of hemolysis
pts with hemolytic anemia share common signs and symptoms regardless fo teh underlying etiology
Anemia and hyperbilirubinemia
Other characteristic features are related to the underlying pathology causing the hemolysis (vasoocclusive crisis in SCA)
