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HEMOLYTIC ANEMIAS. LEARNING OBJECTIVE. 1. To compare and contrast intravascular and extravascular hemolysis 2. To acquire basic knowledge about the tests which are indicative of increased red cell destruction; increased red cell production
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LEARNING OBJECTIVE 1. To compare and contrast intravascular and extravascular hemolysis 2. To acquire basic knowledge about the tests which are indicative of increased red cell destruction; increased red cell production 3. To emphasize on the peripheral and bone marrow changes seen in response to excessive red cell destruction
TYPES OF HAEMOLYSIS • Intravascular haemolysisExtravascular haemolysis
INTRAVASCULAR HAEMOLYSIS - Mismatched blood Transfusion - Drug induced - Disseminated Intravascular Coagulation (DIC) - Paroxysmal nocturnal haemoglobinuria (PNH) - G 6-PD deficiency
EXTRAVASCULAR HAEMOLYSIS - Membrane defects (HS) - Immune haemolytic anaemia - Thalassaemia syndrome
LABORATORY TESTS FOR INCREASED RED BLOOD CELL DESTRUCTION EXTRAVASCULAR RED CELL DESTRUCTION • Serum bilirubin - increased • Serum heptoglobin - decreased • Serum LDH - increased • Increased urinary and fecal urobilinogen • Bone marrow iron - increased
LABORATORY TESTS FOR INCREASED RED BLOOD CELL DESTRUCTION CONTD… INTRAVASCULAR RED CELL DESTRUCTION • Serum bilirubin - increased • Serum heptoglobin - decreased • Serum LDH - Increased • urinary and fecal urobilinogen • Hemoglobinaemia and hemoglobinuria • Methaemalbuminaemia • Urinalysis - Hemosiderinuria • Bone marrow iron stores - Decreased
LABORATORY TESTS FOR INCREASED RED BLOOD CELL PRODUCTION • Reticulocytosis • Bone marrow - Increased erythropoeisis • Serum folate - decreased
LABORATORY FEATURES(MORPHOLOGICAL) SPECIALIZED TESTS: 1. SUPRA-VITAL STAIN - Reticulocytosis - Hb-H inclusions - Heinz bodies 2. COOMB’S TEST - Direct ( Antibody-coated red cells) - Indirect ( Serum antibodies)
LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. 3. Osmotic fragility - Hereditary spherocytosis 4. G-6PD deficiency screening test 5. Hb-Electrophoresis - Thalassaemia syndromes
LABORATORY FEATURES(MORPHOLOGICAL) A. PERIPHERAL BLOOD FILM - Anisocytosis - Poikilocytosis - Polychromasia - Target cells - Schistocytosis(fragmented RBC,s) - Spherocytosis - Reticulocytosis
LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. - Helmet cells - Bitten cells, triangle cells - Red cells inclusions: • Heinz bodies • Howell Jolly(H.J) bodies
LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. B – BONE MARROW FINDINGS - Hypercellular - Erythroid hyperplasia - Megaloblastoid changes - Bone marrow – incresaed iron