Never say No, never say, ‘I cannot’, for
you are infinite. Even time and space
are as nothing compared with your
nature. You can do anything and
everything.
-- Swami Vivekananda
….. foundation of clinical medicine
Shashidhar Venkatesh MurthyA/Prof & Head of Pathology
College of Medicine & Dentistry
Clinical Pathology:
RBC 1.3: Hemolytic Anemia - Acquired
CPC : Term2 Week1 - Haem 1/2.
System : Haematology - RBC Disorders.
Topic : 1: Anemia Intro 2: IDA, MBA & ACD 3: Acquired HA 4: Congenital HA. 5: Others.
Pathogenetic Classification of Anemia:
Decreased Production:
Nutrient Deficiency.
Iron def (IDA) / Megaloblastic (MBA)
Hemopoietic cell defect:
Anemia of chronic disorders (ACD)
Aplastic anemia (AA).
Dysplastic anemia. Myelodysplastic Syndromes
Increased loss / destruction:
Blood loss anemia – Acute / Chronic - bleeding.
Hemolytic anemia – Congenital / Acquired.
Acquired / External injury.
Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites
Congenital / Internal RBC defect Defective Membrane (Spherocytic an)
Defective Hemoglobin (Sickle cell an.)
Deficient Enzyme (G6PD)3
2
Top 6 Anemias:
1. Iron Def. A
2. Megaloblastic
3. Anem. Of Chronic Dis.
4. Aplastic An.
5. Immune Hemolytic – Warm
6. Immune Hemolytic - Cold
Haemolytic Anemia: Introduction
Anemia due to Increased RBC destruction
life span (<120d) - Abnormal forms
Bilirubin Jaundice (Unconjugated)
RBC production – BM Hyperplasia &
Reticulocytes.
Acute: Pallor, Jaundice (normal urine)
Chronic: Splenomegaly, pigment gall stones.
Intravascular & Extravascular Hemolysis*.
Jaundice
2. Jaundice
4. Splenomegaly
3. Pigment Gall stones
1. Pallor
Immune
Mech.
Infection
Porphyrin Bil. Unconj
Globins
Iron
Bil. ConjConjugation
Normal
Intravascular Hemolysis.
Etiology:
Immune, Mechanical, Enzyme def.
transfusion mismatch, drugs,
infections.
Lab diagnosis:
Absent Haptoglobins.
Haemoglobinemia
Haemoglobinuria
Haemosiderinuria
Clinical features:
Shock,
Renal failure,
In Extravascular Hemolysis:
Unconjugated hyperbilirubinemia only* 5
Breakdown of RBC within Blood Vessel
Renal
failure
FBC Result: Hemolytic Anemia.
6
Hemolytic anemia: Morphology
7
Abnormal RBC shapesspherocytes in WIHA, target forms
in thalasssemia etc.
Polychromatophils.(Immature RBC - large, bluish, no
central palor - Reticulocytes)
Nucleated RBCsmall nucleus inside reticulocyte.
ThalassemiaWarm Ab Hemolytic Anemia
Giems stain (routine blood film) Bluish, Large RBC ( MCV)
Hemolytic Anemia: Reticulocytes
Reticulocyte
RBC
Reticulocytosis Increased RBC production
Methylene blue stain
for cytoplasmic RNA
Giemsa stain (routine blood film) Bluish, Large RBC ( MCV)
Only educated person is
one who has learned how
to learn and change.
-- Carl Rogers
Cell Mem
Hb
Enzymes
Haemolytic Anemia: classification
Acquired / External Injury:
Immune: IgG / Warm & IgM / Cold
Physical: valve dis, March Hb.nuria, trauma, burns.
Drugs: α-Methyldopa, cephalosporins, ibuprofen etc.
Parasites / infections (malaria, septicemia (DIC)
Congenital / Internal defects: Defective Membrane: Spherocytic anemia.
Defective Haemoglobin: Sickle cell anemia, Thalassemia
Deficient Enzyme: G6PD deficiency anemia.
10
Immune Hemolytic anemia IgG/IgM:
11
Causes:
RBC Antibody (Commonest.)
Pathogenesis:
Warm / IgG coated RBC lysis in spleen. Drugs,
Idiopathic. (predominantly extravascular)
Cold / IgM - (Infections, Lymphoma) RBC
Clumping & complement fixation lysis in BV &
Liver. (predominantly intravascular)
Morphology:
Spherocytes (warm) / RBC clumps (cold).
Clinical Features:
Anemia, Jaundice. Splenomegaly in chronic.
Diagnosis: Comb’s test *.
IgG
WARM
IgM
COLD
WARM / IgG
COLD / IgM
IgG Antibody
AIHA: Lab diagnosis – Coombs test.
12
Direct Coombs Test:
(for antigen on patient RBC)
Indirect Coombs Test:
(for antibodies in the serum.)Pos
Neg
Online Video Tutorial
Patient RBC Patient Serum
MAHA - Microangiopathic Hemolytic An.
Mechanical damage:
Etiology:
DIC, TTP, HUS
Valve disease / Artificial valves.
March Hemoglobinuria.
Morphology:
Fragmented RBC: Schistocytes.
Polychromasia – reticulocytes.
13
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The only person who never makes
a mistake is a person who
never does anything…!
- Theodore Roosevelt
Need help? contact me…
1. Office location: DB39-136 (Townsville)
2. Office Tel: 4781 4566
3. Email: [email protected]
4. Emergency?: 0416933704
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You are the stone..
The pessimist waits for better times,
and expects to keep on waiting; the
optimist goes to work with the best
that is at hand now, and proceeds to
create better times.
-- Christian D. Larson
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