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 PathologyCollege of Medicine & Dentistry

Clinical Pathology: RBC 1.3: Hemolytic Anemia - Acquired

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)

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2

Top 6 Anemias:1. Iron Def. A2. Megaloblastic3. Anem. Of Chronic Dis.4. Aplastic An.5. Immune Hemolytic – Warm6. 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

ImmuneMech.Infection

Porphyrin Bil. Unconj

GlobinsIron

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

Renalfailure

FBC Result: Hemolytic Anemia.

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Hemolytic anemia: Morphology

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Abnormal RBC shapesspherocytes in WIHA, target forms in thalasssemia etc.

Polychromatophils.(Immature RBC - large, bluish, no central palor - Reticulocytes)

Nucleated RBCsmall nucleus inside reticulocyte.

Thalassemia Warm Ab Hemolytic Anemia

Giems stain (routine blood film) Bluish, Large RBC ( MCV)

Hemolytic Anemia: Reticulocytes

Reticulocyte

RBC

Reticulocytosis Increased RBC production

Methylene blue stainfor 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 MemHb

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.

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Immune Hemolytic anemia IgG/IgM:

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.

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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.

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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 45663. Email: venkatesh.shashidhar@jcu.edu.au4. Emergency?: 0416933704

Need personal coaching?Email me for an appointment.

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