Acquired Hemolytic Anemias DR. Sana D. Jalal

Acquired Hemolytic Anemias

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Acquired Hemolytic Anemias. DR. Sana D. Jalal. Immune Hemolytic anemia. Autoimmune. Alloimmune. Drugs. Hemolytic Transfusion reaction. Hemolytic Disease of the Newborn. Warm. Cold. Etiology of Warm AIHA. Idiopathic : (in about one third of cases) - PowerPoint PPT Presentation

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Page 1: Acquired Hemolytic Anemias

Acquired Hemolytic Anemias

DR. Sana D. Jalal

Page 2: Acquired Hemolytic Anemias

Immune Hemolytic anemia

Autoimmune Alloimmune Drugs

Warm Cold Hemolytic Transfusion reaction

Hemolytic Disease of the Newborn

Page 3: Acquired Hemolytic Anemias

Etiology of Warm AIHA

1.1. Idiopathic :Idiopathic : (in about one third of cases)

2. 2. Secondary: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.

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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).

Page 5: Acquired Hemolytic Anemias

Blood Picture in warm AIHA

Variable anemia, normochromic, spherocytes and micro-spherocytes with polychromasia

Page 6: Acquired Hemolytic Anemias

• Most important is the Direct Coomb’s TestDirect Coomb’s Test, and if positive, it is of diagnostic value.

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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.

Page 9: Acquired Hemolytic Anemias

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.

Page 10: Acquired Hemolytic Anemias

Blood film in cold AIHA

Direct Coomb’s testDirect Coomb’s test is classically positive.Detection of significant cold antibodies by the cold agglutinin titre tests.

Page 11: Acquired Hemolytic Anemias

•Aplastic Anemia

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• 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.

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Idiopathic Drugs related Irradiation Infective agents

> 2/3 of cases

a.Cytotoxic drugs.

b.Other drugs Chloramph-enicol, Benzene, sulphonamide

Hepatitis, HIV, EBVirus etc.

Page 14: Acquired Hemolytic Anemias

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.

Page 15: Acquired Hemolytic Anemias

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.

Page 16: Acquired Hemolytic Anemias

Bone Marrow Findings

Page 17: Acquired Hemolytic Anemias

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