HEMOLYTIC ANEMIAS

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HEMOLYTIC ANEMIAS
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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

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TYPES OF HAEMOLYSIS

• Intravascular haemolysis Extravascular
  haemolysis

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INTRAVASCULAR HAEMOLYSIS

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

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EXTRAVASCULAR HAEMOLYSIS

• - Membrane defects (HS)
• - Immune haemolytic anaemia
• - Thalassaemia syndrome

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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

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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

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LABORATORY TESTS FOR INCREASED RED BLOOD CELL
PRODUCTION

• Reticulocytosis
• Bone marrow - Increased erythropoeisis
• Serum folate - decreased

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LABORATORY FEATURES(MORPHOLOGICAL)

• SPECIALIZED TESTS
• 1. SUPRA-VITAL STAIN
• - Reticulocytosis
• - Hb-H inclusions
• - Heinz bodies
• 2. COOMBS TEST
• - Direct ( Antibody-coated red
  cells)
• - Indirect ( Serum antibodies)

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LABORATORY FEATURES(MORPHOLOGICAL) CONTD..

• 3. Osmotic fragility
• - Hereditary spherocytosis
• 4. G-6PD deficiency screening test
• 5. Hb-Electrophoresis
• - Thalassaemia syndromes

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LABORATORY FEATURES(MORPHOLOGICAL)

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

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LABORATORY FEATURES(MORPHOLOGICAL) CONTD..

• - Helmet cells
• - Bitten cells, triangle cells
• - Red cells inclusions
• Heinz bodies
• Howell Jolly(H.J) bodies

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LABORATORY FEATURES(MORPHOLOGICAL) CONTD..

• B BONE MARROW FINDINGS
• - Hypercellular
• - Erythroid hyperplasia
• - Megaloblastoid changes
• - Bone marrow incresaed iron

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