haemolytic anaemia
admittedly I still don't really get it.
a definition of sorts
- shortened RBC lifespan
clinical presentation
associated disease states etc
- sepsis (causes every bad thing)
- Malaria clinical presentation
the causes are many: classify or die
- intravascular
- immune-mediated vs non-immune-mediated?
- extravascular
- intrinsic to RBC vs extrinsic?
| Intravascular | Extravascular |
|---|---|
| Immune - ABO or Rhesus incompatibility - Haemolytic disease of the newborn (HDN) - Transfusion mismatch - IgG-mediated “warm” autoimmune haemolytic anaemia (AIHA) - drugs e.g. methyldopa, penicillin, cephalosporins, erythromycin, probenecid, paracetamol and ibuprofen - autoimmune diseases e.g. antiphospholipid syndrome, SLE, Rheumatoid arthritis - lymphoproliferative diseases e.g. lymphoma, CLL - idiopathic - “cold” AIHA = complement-mediated Non-immune - mechanical e.g. cardiac peri-prosthetic or peri-valvular leaks, intravascular devices (e.g. TIPS), extracorporeal circuits (e.g. ECMO, RRT) - infection - e.g. severe sepsis, malaria (e.g. blackwater fever), Clostridium perfringens (Necrotising fasciitis), babeosis - hypotonic solutions and drowning - toxins e.g. heavy metals, oxidants (e.g. causes of Methaemoglobinaemia), sodium chlorate - Microangiopathic haemolytic anaemia (MAHA) - e.g. envenoming (e.g. australian elapid), malignancy, malignant hypertension, sisseminated intravascular coagulation (DIC), pre-eclampsia/eclampsia - Thrombotic microangiopathy (MAHA, thrombosis and thrombocytopenia), e.g. HUS, TTP and HELLP - Trauma, burns - Liver disease - e.g. Zieve’s syndrome due to alcoholic cirrhosis, Wilson’s disease |
Intrinsic - enzyme abnormalities - G6PD deficiency - pyruvate kinase deficiency - membrane abnormalities - hereditary spherocytosis - hereditary eliptocytosis - paroxysmal nocturnal hemoglobinuria - hemoglobinopathies - Sickle cell disease - thalassemia Extrinsic hypersplenism - portal hypertension from liver disease - myeloproliferative diseases - tropical splenomegaly syndrome |
or: warm vs cold (...)
diagnostic investigations
- Hb (expect ↓)
- reticulocytes (expect ↑)
- LDH (expect ↑)
- LFTs (expect ↑ indirect/unconjugated bilirubin)
- Intravascular: haemoglobinuria, haemosiderinuria, ↓ haptoglobin