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HEMOLYTIC ANEMIAS

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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HEMOLYTIC ANEMIAS

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  1. HEMOLYTIC ANEMIAS

  2. 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

  3. TYPES OF HAEMOLYSIS • Intravascular haemolysisExtravascular haemolysis

  4. INTRAVASCULAR HAEMOLYSIS - Mismatched blood Transfusion - Drug induced - Disseminated Intravascular Coagulation (DIC) - Paroxysmal nocturnal haemoglobinuria (PNH) - G 6-PD deficiency

  5. EXTRAVASCULAR HAEMOLYSIS - Membrane defects (HS) - Immune haemolytic anaemia - Thalassaemia syndrome

  6. 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

  7. 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

  8. LABORATORY TESTS FOR INCREASED RED BLOOD CELL PRODUCTION • Reticulocytosis • Bone marrow - Increased erythropoeisis • Serum folate - decreased

  9. 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)

  10. LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. 3. Osmotic fragility - Hereditary spherocytosis 4. G-6PD deficiency screening test 5. Hb-Electrophoresis - Thalassaemia syndromes

  11. LABORATORY FEATURES(MORPHOLOGICAL) A. PERIPHERAL BLOOD FILM - Anisocytosis - Poikilocytosis - Polychromasia - Target cells - Schistocytosis(fragmented RBC,s) - Spherocytosis - Reticulocytosis

  12. LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. - Helmet cells - Bitten cells, triangle cells - Red cells inclusions: • Heinz bodies • Howell Jolly(H.J) bodies

  13. LABORATORY FEATURES(MORPHOLOGICAL) CONTD.. B – BONE MARROW FINDINGS - Hypercellular - Erythroid hyperplasia - Megaloblastoid changes - Bone marrow – incresaed iron

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