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Acquired hemolytic anaemia

Immune haemolytic anaemias. A

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Acquired hemolytic anaemia

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    1. Acquired hemolytic anaemia Dr. Fatma Al-Qahtani

    2. Immune haemolytic anaemias A – Auto immune .H.A Are caused by AB production by the body against its own red cells. C/BY apositive (DAT) / Coomb’s test. Divided into ? 1) warm? 37c 2) cold ? 4 c

    4. Warm AIHA IgG alone or with complement and take up by RE macrophages More in spleen Spherocytosis prominent DAT is positive Bind at 37c

    5. Cold AIHA The AB ? monoclonal ? ICHS , lymphoproliferative disorder ? Polyclonal ? infection ? IM, MP Usually IgM Bind to red cell at 4c Mild jaundice and splenomegaly Spherocytosis is less marked

    6. B. Alloimmune hemolytic anemias Hemolytic transfusion reactions Hemolytic disease of the newborn Allograft associated C. Drug-induced immune hemolytic anemia Drug absorption mechanism Membrane modification mechanism Immune complex mechanism

    7. Coombs Test Antiglobulin Test

    8. Coombs Test Antiglobulin Test

    9. Non-Immune Hemolytic Anemias Hemolytic anaemias due to mechanisms or agents other than antibodies +/or complement e.g.: Mechanical (traumatic) (fragmentation) Toxins Infections Splenomegaly (hypersplenism) Burn (physical) Renal failure and liver failure Chemical

    10. Non-Immune Acquired Hemolytic Anemia

    11. Non-Immune Acquired Hemolytic Anemia

    12. Mechanical (Traumatic) (Fragmentation) This is due to direct trauma (stress) to the RBCs causing fragmentation of the RBCs & intra-vascular hemolysis. The fragmented cells can be seen on peripheral blood smears & are called (schistocytes). Types: Cardiac – most common Due to: Prosthetic valves Patches Valvular diseasse e.g., stenosis

    13. Mechanical (Traumatic) (Fragmentation) (cont…) Microangiopathic: mechanical hemolysis due to contact between the RBCs & the abnormal intema of thrombosed, narrowed, necrotic small vessels or fibrin strand formation. Caused by many diseases e.g., DIC (disseminated intravascular coagulation), malignant hypertension, disseminated malignancies especially mucin secreting adenocarcinomas, TTP (thrombocytopenic purpura), hemolytic uremic syndrome (HUS).

    14. Causes of Microangiopathic Hemolytic Anemia

    15. Causes of Microangiopathic Hemolytic Anemia (cont…)

    16. Mechanical (Traumatic) (Fragmentation) (cont…) Causes intravascular hemolysis Hemoglobinurea Hemoglobinemia Low haptoglobin Fragmented RBCs (schistocytes) on peripheral blood film Hemosidrinurea

    18. Clostidium Perfringens: Due to action of lipase and proteinase enzymes produced by the organism. Meningococcal: Due to DIC

    19. Malaria due to: Direct invasion causing intravascular lysis &/or extravascular lysis. Immune complex formation. Splenomegaly. Black water fever: Is an example of severe intravascular hemolysis due to falciparum sp.

    20. Chemical: e.g., some toxins e.g., spider venom, snake venom, bacterial toxins, arsenic (As), (Cu). Physical: Burn: characterized by the presence of many spherocytes in the peripheral blood. Splenomegaly Renal failure and liver failure Due to change in the metabolic structure of the RBCs,

    22. Hemolytic Uremic Syndrome Acquired-disorder affecting mainly infants and children. Characterized by: Intravascular hemolysis Renal failure Thrombocytopenia

    23. Classification Sporadic: Occuring denovo with no preceeding disease. Believed to be due to an inherited defect in vascular hemostasis. Epidemic, typical form: Following a systemic illness of fever, diarrhea and vomiting. In many cases, no organisms are identified. However, in some cultures are positive e.g., for E. coli. Mechanisms: Endothelial swelling & disruption resulting in platelet deposition on the vessel wall.

    24. Clinical Features Jaundice, hemoglobinuria, proteinuria. Hypertension, uremia, oliguria. Anemia, thrombocytopenia purpura. CNS – unusual: convulsion, coma

    25. Laboratory Findings (Cont…) Chemistry: Elevated urea Elevated creatinine Elevated bilirubin Proteinuria + hemoglobinuria Coagulation: Prolonged PT, PTT but not always

    26. Laboratory Findings Blood film: Fragmentation of RBCs Thrombocytopenia Polychromasia CBC: Anemia Thrombocytopenia: usually <50,000 Bone marrow: Hypercellular with increased erythropoiesis + increased megakaryopoiesis

    27. Thank You For Your Attention!

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