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MLAB 1415-Hematology

Keri Brophy-Martinez

Chapter 14: Introduction to

Hemolytic Anemia

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Hemolytic anemia

Anemia caued !y hemolyi o" red!lood cell

Hemolyi i the detruction o"

erythrocyte reulting in the releae o"hemoglo!in

#eult in reduction o" normal red cell

li"epan$ %ormocytic& normochromic anemia

#BC' are prematurely detroyed

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La! 2eature

#eticulocytoi

#I3

rythroid hyperplaia o" !one marro

M: ratio decreaed eripheral !lood

%ormochromic&normocytic

olychromaia

n#BC 6et "or heme cata!olim a!normal

7ncon8ugated+con8ugated !iliru!in

Haptoglo!in

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La! 2eatureIncreased Bone Marrow

Production of Erythrocytes

Increased Erythrocyte

Destruction

#eticulocytoi 9#I3 Anemia

Leu.ocytoi *pherocyte& *chitocyte&oi.ilocyte

n#BC in B ;ecreaed haptoglo!in

olychromaia Increaed !iliru!in

%ormo!latic erythroid hyperplaia in!one marro

Increaed L;H

M: decreaed Increaed uro!ilinogen

Increaed e,pired Caundice

allor

2atigue Cardiac ymptom

?alltone

;ar. or red urine *plenomegaly

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*ite o" ;etruction

Intra0acular

Hemolyi occur ithin the circulation

#BC' are e0erely damaged

,tra0acular

Hemolyi occur ithin themacrophage o" the pleen& li0er or

!one marro

More common than intra0acular

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Intra0acular ;etruction

1$ #BC i hemolyzed

$ 2ree hg! releaed intoplama

@$ Hg! !ind to haptoglo!in

I" haptoglo!indepleted& hemope,incan tep in

4$ 6hi comple, goe toli0er

5$ Comple, con0erted to!iliru!in

$ Biliru!in e,creted tointetinal tract

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6erm

1$ Hemoglo!inemia

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Caue o"Intra0acular Hemolyi

Activation ofComplement onRBC Membrane

Physical orMechanical Traumato the RBC

ToicMicroenvironmentof the RBC

aro,ymal nocturalhemoglo!inuria

Microangiopathichemolytic anemia

Bacterial in"ection

aro,ymal coldhemoglo!inuria

A!normalitie o" heart0eel

Plasmodiumfalciparum in"ection

*ome tran"uionreaction

;ieminatedintra0acularcoagulation

enom

*ome autoimmunehemolytic anemia

6hermal in8ury

Acute drug reaction in?; de(ciency

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,tra0acular ;etruction

1$ Hg! i degraded ithin the phagocyte to hemeand glo!in

a$ hagocyte location:

*pleen: remo0e lightly damaged #BC

Li0er: remo0e e0erely damaged #BC

Bone marro: remo0e mature precuror cell thatare intrinically a!normal

$ Heme "urther degraded to iron& !ili0erdin and

car!on mono,ide@$ Bili0erdin enter plama a !iliru!in

4$ Biliru!in !ind to al!umin& e,creted !y the li0er

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Caue o" ,tra0acularHemolyi

!ri"in Anemias

Inherited #BC ;e"ect 6halaemia&Hemoglo!inopathie& nzymede(ciencie& Mem!rane diorder

Ac/uired #BC ;e"ect Megalo!latic anemia& itamin de(ciency in ne!orn

Immunohemolytic anemia Autoimmune& ;rug induced&*ome tran"uion reaction

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*ource o" ;e"ect o" #BC

Intrinic

A!normality o" the #BC

Mem!rane

Cell enzyme

Hemoglo!in molecule

7ually hereditary

C6I

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*ource o" ;e"ect o" #BC

,trinic

Antagonit in cell' en0ironment cauein8ury to the #BC

Antagonitic plama "actor

6raumatic phyical cell in8ury

Immune mediated cell detruction

#BC i normal

7ually ac/uired

*ite o" hemolyi: intra or e,tra0acular

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#e"erene

Harmening& ;$ M$ 9DDE$ ClinicalHematology and Fundamentals ofhemostasis95th ed$$ hiladelphia&

A: 2$A$ ;a0i Company$

McKenzie& *$ B$ 9D1D$ ClinicalLaboratory Hematology9nd ed$$

7pper *addle #i0er& %>: earonducation& Inc$$