The Diagnosis of Haemolysis

Question 1

Describe the clinical features present in Intravascular Haemolysis.

Answer 1

1. Anemia
2. Iron Deficiency
3. Jaundice is not as prominent
4. Zinc Deficiency
5. (plus-minus) Gall stones (compare with Extravascular)
6. Pulmonary Hypertension

Question 2

Describe the clinical features of Extravascular Haemolysis

Answer 2

1. Anemia
2. Iron Overlaod (compare with Intravascular)
3. Jaundice (compare with Intravascular)
4. No Zinc Deficiency (compare with Intravascular)
5. Gall stones definitely present
6. (plus-minus)Pulmonary hypertension

Question 3

What are the features of Chronic Haemolysis?

Answer 3

1. Iron Overload
2. Iron Deficiency
3. Splenomegaly (oocuring in both I.V and E.V)
4. Skeletal Abnormalities(occuring in both I.V and E.V)
5. Gall bladder disease
6. Folic Acid Deficiency(occurs in both I.V and E.V)- since red cells are rich in folic acid, haemolysis may lead to megaloblastic anaemia due to folic acid loss and consequent deficiency. Provide folate supplementation.
7. Aplastic Crisis (occuring in both I.V and E.V)
8. Pulmonary Hypertension- Nitric Oxide has a vasodilatory effect on the pulmonary vessels. As free Hb in the plasma binds to NO, pulmonary vasocontriction results…from Nitric Oxide depletion.

Question 4

Laboratory Investigations

Describe the Haematological Investigations to diagnose Haemolysis.

Answer 4

1. Full Blood Count (to detect a drop in Hb levels, Increased MCHC {caused by Spherocytosis}, and increased RDW)
2. Morphology of the cells (there’s changes in RBCs such as spherocytosis, fragments etc)
3. COOMB TEST