Haematology: RBC diseases:
p ANAEMIA:
1. Autoimmune haemolytic anaemia:
Mostly due to idiopathic causes or sometimes as a result of medications SE.
*Extrinsic haemolytic anaemia: attacked by immune cells, this is either extravascular
haemolysis in the liver or spleen or intravascular
TYPES:
- Warm: at 37C and more common, due to IgG (warm agglutinins), Fc portion of
antibodies attached to: macrophages, neutrophils and NK cells and CD8+ T cells
cell destruction by phagocytosis in spleen or cytotoxicity
- Cold: rare, at 0-10C, chronic version is due to IgM, and by complement system (MAC
system). An acute version is presented by Raynaud's phenomenon intravascularly.
**considered normocytic anaemia
Complications of intravascular haemolysis:
LDH increases
Dark urine due to increased urobilin level
Jaundice
Gallstones
Reticulocytosis
3. Iron def. anaemia:
Blood film: spherocytes and reticulocytes Causes:
Reduced haptoglobin haemoglobinuria - Blood loss: menorrhagia (
Renal insufficiency secondary to haemoglobinuria and haemosiderinuria (most common cause for
- Inadequate diet: vegans a
*in extravascular haemolysis: - Poor absorption: e.g., in c
Haptoglobin is normal NO haemoglobinuria and NO haemosiderinuria. - Increased requirement: ch
AETIOLOGY:
Signs/ symptoms:
- Warm: viral infection
Lymphoma and CLL - Fatigue
Methyldopa, SLE - SOB
- Cold: lymphoma, EBV, mycoplasma - Palpitations
- Pallor
MANAGEMENT: - Koilonychia
Warm: steroids +/- rituximab - Hair loss
- Glossitis
- Angular stomatitis
2. Investigations:
- Hx and examination: askin
medication list, past medi
- Blood test: FBC, ferritin, T
- Blood film: anisopoikilocy
- +/- endoscopy: rule out G
Hb for men <11 2ww c
Management:
- Find and treat underlying
- PO ferrous sulfate for 3 m
- Iron rich diet: dark green
Serum iron
TIBC
Transferrin satur
Haemolytic anaemia: Ferritin
a. Hereditary causes: 4. Sickle
Hereditary spherocytosis/ elliptocytosis cell anaemia:
G6PD def
Sickle cell, thalassemia Autosomal recessive
b. Acquired: immune causes= + coombs test Defect in a gene in the beta ch
Autoimmune: warm vs. cold Abnormally shaped RBCs can o
Alloimmune: transfusion reaction, haemolytic disease new-born vessels and blood flow
Meds: methyldopa, penicillin Associated to reduced life exp
Others: - Coombs test
p ANAEMIA:
1. Autoimmune haemolytic anaemia:
Mostly due to idiopathic causes or sometimes as a result of medications SE.
*Extrinsic haemolytic anaemia: attacked by immune cells, this is either extravascular
haemolysis in the liver or spleen or intravascular
TYPES:
- Warm: at 37C and more common, due to IgG (warm agglutinins), Fc portion of
antibodies attached to: macrophages, neutrophils and NK cells and CD8+ T cells
cell destruction by phagocytosis in spleen or cytotoxicity
- Cold: rare, at 0-10C, chronic version is due to IgM, and by complement system (MAC
system). An acute version is presented by Raynaud's phenomenon intravascularly.
**considered normocytic anaemia
Complications of intravascular haemolysis:
LDH increases
Dark urine due to increased urobilin level
Jaundice
Gallstones
Reticulocytosis
3. Iron def. anaemia:
Blood film: spherocytes and reticulocytes Causes:
Reduced haptoglobin haemoglobinuria - Blood loss: menorrhagia (
Renal insufficiency secondary to haemoglobinuria and haemosiderinuria (most common cause for
- Inadequate diet: vegans a
*in extravascular haemolysis: - Poor absorption: e.g., in c
Haptoglobin is normal NO haemoglobinuria and NO haemosiderinuria. - Increased requirement: ch
AETIOLOGY:
Signs/ symptoms:
- Warm: viral infection
Lymphoma and CLL - Fatigue
Methyldopa, SLE - SOB
- Cold: lymphoma, EBV, mycoplasma - Palpitations
- Pallor
MANAGEMENT: - Koilonychia
Warm: steroids +/- rituximab - Hair loss
- Glossitis
- Angular stomatitis
2. Investigations:
- Hx and examination: askin
medication list, past medi
- Blood test: FBC, ferritin, T
- Blood film: anisopoikilocy
- +/- endoscopy: rule out G
Hb for men <11 2ww c
Management:
- Find and treat underlying
- PO ferrous sulfate for 3 m
- Iron rich diet: dark green
Serum iron
TIBC
Transferrin satur
Haemolytic anaemia: Ferritin
a. Hereditary causes: 4. Sickle
Hereditary spherocytosis/ elliptocytosis cell anaemia:
G6PD def
Sickle cell, thalassemia Autosomal recessive
b. Acquired: immune causes= + coombs test Defect in a gene in the beta ch
Autoimmune: warm vs. cold Abnormally shaped RBCs can o
Alloimmune: transfusion reaction, haemolytic disease new-born vessels and blood flow
Meds: methyldopa, penicillin Associated to reduced life exp
Others: - Coombs test
