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Anemia3 Hemolytic acquired

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  1. 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

  2. Shashidhar Venkatesh Murthy A/Prof & Head of Pathology College of Medicine & Dentistry ….. foundation of clinical medicine Clinical Pathology: RBC 1.3: Hemolytic Anemia - Acquired

  3. Pathogenetic Classification of Anemia: 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  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) 2 3

  4. 1. Pallor 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*. 2. Jaundice Jaundice 3. Pigment Gall stones Globins Iron Immune Mech. Infection Conjugation Bil. Conj Normal Porphyrin   Bil. Unconj 4. Splenomegaly

  5. Intravascular Hemolysis. Breakdown of RBC within Blood Vessel  Etiology:  Immune, Mechanical, Enzyme def. transfusion mismatch, drugs, infections.  Lab diagnosis:  Absent Haptoglobins.  Haemoglobinemia  Haemoglobinuria  Haemosiderinuria  Clinical features:  Shock,  Renal failure, Renal failure In Extravascular Hemolysis: Unconjugated hyperbilirubinemia only* 5

  6. FBC Result: Hemolytic Anemia. 6

  7. Hemolytic anemia: Morphology  Abnormal RBC shapes spherocytes in WIHA, target forms in thalasssemia etc.  Polychromatophils. (Immature RBC - large, bluish, no central palor - Reticulocytes)  Nucleated RBC small nucleus inside reticulocyte. Giems stain (routine blood film)  Bluish, Large RBC ( MCV) Warm Ab Hemolytic Anemia Thalassemia 7

  8. Hemolytic Anemia:  Reticulocytes Methylene blue stain for cytoplasmic RNA Reticulocyte RBC Giemsa stain (routine blood film)   Bluish, Large RBC (  MCV) Reticulocytosis  Increased RBC production

  9. Only educated person is one who has learned how to learn and change. -- Carl Rogers

  10. 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. Cell Mem Hb Enzymes 10

  11. 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 IgM IgG Antibody COLD WARM WARM / IgG COLD / IgM

  12. AIHA: Lab diagnosis – Coombs test. Patient RBC Patient Serum Direct Coombs Test: (for antigen on patient RBC) Indirect Coombs Test: (for antibodies in the serum.) Pos Neg Online Video Tutorial 12

  13. MAHA - Microangiopathic Hemolytic An. Mechanical damage: Etiology:  DIC, TTP, HUS  Valve disease / Artificial valves.  March Hemoglobinuria. Morphology:  Fragmented RBC: Schistocytes.  Polychromasia – reticulocytes. 13

  14. The only person who never makes a mistake is a person who never does anything…! - Theodore Roosevelt 14

  15. You are the stone.. Need help? contact me… 1. Office location: DB39-136 (Townsville) 2. Office Tel: 4781 4566 3. Email: venkatesh.shashidhar@jcu.edu.au 4. Emergency?: 0416933704 Need personal coaching? Email me for an appointment.

  16. 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