Haemolytic Anaemia: Warm And Cold And Malaria Flashcards
(17 cards)
What is warm AIHA?
An IgG-mediated extravascular haemolytic disease, in which the spleen tags cells for splenic phagocytosis.
It is most common and occurs at any age.
What is the cause of warm AIHA?
SLE, idiopathic, lymphoproliferative neoplasms (eg. chronic lymphocytic leukaemia and lymphoma), drugs (methyldopa)
How is warm AIHA managed?
Managed with prednisolone or immunosupression (e.g. AZT) and transfusions if severe
What is cold AIHA?
IgM-mediated haemolytic disease, in which IgM fixes complement causing direct intravascular haemolysis. It includes cold agglutinin disease
The IgM agglutinates also cause the hands and feet to become blue in cold conditions (acrocyanosis)
IgM looks like a snowflake.
What is the cause of cold AIHA?
post-infectious (usually after Mycoplasma or EBV), idiopathic, lymphoproliferative disorders
It affects those between 40-80 and occurs at cold temps below 37 degree body temp
What is the management of AIHA?
supportive, warmed blood is transfused if required and resistant cases may trial rituximab
What is the treatment of acute and severe malaria?
Artesenate which inhibits haem polymerisation
How does haemolytic anaemia affect HbA1?
Falsely low Hb A1c due to reduced red cell life span
How is HbA1c affected after a splenectomy?
Falsely high HbA1c as RBC now have a higher lifespan and able to become glycosylated
Which prophylactic antibiotic should be given after splenectomy?
Phenoxymethylpenicilin
How does warm haemolytic anaemia present?
Splenomegaly causing full feeling
DVT
PE
Which condition requires splenectomy at a young age in childhood?
Hereditary spherocytosis
How does cold haemolytic anaemia present?
Cold fingers and toes
Raynaud’s
What are the specific tests for haemolytic anaemia?
Coombs test for autoantibodies
Thermal amplitude test to differentiate between cod and warm
What will the blood count show?
High reticulocyte count
High bilirubin
High lactate dehydrogenase
Low Hb and haematocrit
What is the treatment of warm AHA?
Immunosuppressants like mycophenolate mofetil
Azathriopine
Cyclophosphamide
Severe cases may invovle blood transfusions and splenectomy
What is the treatment of Cold haemolytic anaemia?
Avoid exposure to cold
Rituximab in combination with prednisone or chemotherapy agent
Blood transfusions.
