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Outcome : The student will know : -The types of acquired hemolytic anemias

Course title: Hematology (1) Course code: MLHE-201 Supervisor: Prof. Dr Magda Sultan Date : 26/12/2013 . Outcome : The student will know : -The types of acquired hemolytic anemias -The diagnosis of acquired hemolytic anemias -The laboratory tests needed for diagnosis. 2-hemolytic anemias.

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Outcome : The student will know : -The types of acquired hemolytic anemias

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  1. Course title: Hematology (1)Course code: MLHE-201 Supervisor: Prof. Dr Magda SultanDate : 26/12/2013 Outcome : The student will know : -The types of acquired hemolytic anemias -The diagnosis of acquired hemolytic anemias -The laboratory tests needed for diagnosis

  2. 2-hemolytic anemias • Acquired hemolytic anaemia • Antibodies directed against RBC membrane components • autoimmune hemolytic anemia, delayed transfusion reaction, some drug-induced hemolytic anemias). • Stasis, trapping, and destruction of RBC in an enlarged spleen

  3. Introduction • Increased RBC Destruction – • Short RBC life span <120 days. • Normocyticnormochromic, reticulocytosis • Anemia, Jaundice, marrow hyperplasia • Splenomegaly, increased bilirubin

  4. Types of acquired HA • AutoImmune Haemolytic Anemias • (+ve Direct CoombꞋs) • Alloimmunehaemolyticanemias • Drug-induced immune haemolyticanemias • Infections • Chemical & physical agents • Secondary Haemolyticanemias • Paroxysmal Nocturnal Haemoglobinuria (PNH)

  5. Classification of hemolytic anemias===Acquired=== ‘A-''Immune mediated hemolytic anemia''' (direct Coombs test is positive) 1 *Autoimmune hemolytic anemia **Warm antibody autoimmune hemolytic anemia **Cold antibody autoimmune hemolytic anemia

  6. ‘ • 2*Alloimmunehemolytic anemia **Hemolytic disease of the newborn (HDN) **Alloimmune hemolytic blood transfusion reactions (ie from a non-compatible blood type) • 3*Drug induced immune mediated hemolytic anemia **Penicillin (high dose) **Methyldopa

  7. B-'''Non-immune mediated haemolyticanaemia''' (direct Coombs test is negative) *Drugs *Toxins *Trauma *Infections *Hypersplenism

  8. Assesment of HA Clinicalfeatures:-pallor-jaundice-splenomegaly

  9. Laboratory features:1. Laboratory features- normocytic, normochromic anemia - reticulocytosis - antiglobulin Coombs’ test is positive2. Blood smear - anisopoikilocytosis, spherocytes - normoblasts - schistocytes3. Bone marrow smear - erythroid hyperplasia

  10. DIRECT ANTIGLOBULIN TEST (DAT)Coomb′s test

  11. Procedure of DAT • Take 2-3 drops of blood to be tested in a clean labeled tube. • Wash the red cells 3-4 times in a large volume of saline to remove free globulin molecules. Remove all supernatant after each wash. Completely decant the final supernatant wash. • Add 2 drops of polyspecific AHG serum in 1 drop of sensitized washed red cells or in 1 drop of 3-5 % suspension of sensitized cells immediately. • Mix, Centrifuge at 1000 rpm for 1 minutes immediately. • Gently shake the tube to dislodge the cell button and see for agglutination, use optical aid if needed. Record the result. • Add 1 drop of IgG coated red cells to a negative test. Mix, centrifuge at 1000 rpm for 1 min. Immediately look for agglutination. If a negative result (no agglutination) is obtained the test result is invalid and whole test should be repeated. If agglutination is obtained, the result is valid.

  12. Indirect antiglobulin (coomb′s ) test

  13. Procedure: • Place 2-3 drops of the test serum in a tube. Serum should be fresh for detecting complement components and complement binding antibodies, otherwise, fresh AB serum should be added to it. • Add 1 drop of 3-5% suspension of washed O Rh (D) positive red cells to the serum in the tube. • Mix and incubate at 37°C for 30-40 minutes. • Centrifuge at 1000 rpm for 1 minutes. • Examine for hemolysis and/or agglutination. Use optical aid if necessary. Agglutination at this stage indicates the presence of saline (complete) antibodies. • If no agglutination is seen, wash cells 3-4 times in large volume of saline. Decant supernatant in each wash as completely as possible.

  14. Procedure: • Add 2 drops of AHG serum to the cells. • Mix and centrifuge at 1000 rpm for 1 minutes immediately. • Gently shake the tube to dislodge the button and examine for agglutination, using optical aid. Record the result. • Add 1 drop of IgG coated red cells to any test that is negative. Mix and centrifuge at 1000 rpm for 1 minutes. Look for agglutination. If there is no agglutination, the test result is invalid and the whole test is repeated. If agglutination is obtained the result is valid. • Auto control should be kept with IAT.

  15. Assignement :

  16. Training questions :What are the tests of hemolysis ? • How to diagnose Autoimmune hemolytic anaemia ? • Reference book : • Essential Hematology . • Dacie .

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