Download HAEMOLYTIC ANAEMIAS

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
3. To emphasize on the peripheral and bone
marrow changes seen in response to excessive
red cell destruction
TYPES OF HAEMOLYSIS
Intravascular haemolysis
Extravascular 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
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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
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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
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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