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Acquired Hemolytic Anemias
DR. Sana D. Jalal
Immune Hemolytic anemia
Autoimmune
Warm
Cold
Alloimmune
Hemolytic
Transfusion
reaction
Hemolytic
Disease of
the Newborn
Drugs
Etiology of Warm AIHA
1. Idiopathic : (in about one third of cases)
2. Secondary: in association with other disorders
including autoimmune disorders, lymphomas
and some drugs like aldomet.
auto-antibody best reacts with
red cells at 37C, IgG class,
usually associated with
extravascular hemolysis.
Clinical Features of Warm AIHA
• Usually with insidious onset of pallor and jaundice
with splenomegaly .
• Signs and symptoms of SLE, lymphoma or history of
drug intake due to hypertension.(secondary cases).
Blood Picture in warm AIHA
Variable anemia, normochromic, spherocytes and microspherocytes with polychromasia
• Most important is the Direct Coomb’s Test,
and if positive, it is of diagnostic value.
Cold Autoimmune HA
• Cold AIHA may be
1. Idiopathic.
2. Secondary : in association with lymphomas
and certain infections like Mycoplasma
pneumoniae.
autoantibody reacts best
with RBC in the cold at
4C, IgM class, with the
capacity to intravascular
lysis.
Clinical Features of cold AIHA:
• In most idiopathic cases the patients have
persistent pallor with or without jaundice.
• Alternatively patients may have episodes of
hemoglobinuria, induced by chilling or a
combination of these two patterns may also occur.
• Cold mediated vaso-occlusion phenomena like
acrocyanosis may be encountered.
• Splenomegaly is commonly encountered.
Blood film in cold AIHA
Direct Coomb’s test is
classically positive.
Detection of significant cold
antibodies by the cold
agglutinin titre tests.
•Aplastic Anemia
Definition
• Pancytopenia in the blood and a hypocellular marrow
in which normal haemopoietic elements are replaced
by fat cells.
• Abnormal cells are not present in the peripheral
blood or bone marrow.
Etiology
Idiopathic
> 2/3 of
cases
Drugs related
a.Cytotoxic
drugs.
b.Other drugs
Chloramphenicol,
Benzene,
sulphonamide
Irradiation
Infective
agents
Hepatitis,
HIV, EBVirus
etc.
Clinical Manifestations
1.Bleeding tendency, Purpura , mucous
membrane bleeding, e,g epistaxis, GI blood
loss , bleeding per vagina.
2. Tiredness.
3. Infections.
4. No jaundice.
5. No organomegaly.
Blood Picture
• Pancytopenia ( reduction in Red cells (HB), WBC, and
Platelets).
• CBP Findings :
Red cells : normochromic, usually macrocytic, with
reduced retics.
Red cell indices : MCV usually increased, MCH and
MCHC usually normal.
Bone Marrow Findings
Anemia of Chronic Disease
• Chronic infection, inflammation or malignancy
– TB, lung abscess, HIV
– RA, SLE, or other autoimmune dz
– Malignancy
• Release of inflammatory cytokines suppresses
erythropoiesis
• Hallmarks—low serum iron, low TIBC/transferrin,
normal/increased ferritin
.