Introduction to Haemolytic Anaemia

Question 1

What is Haemolytic Anaemia

Answer 1

Anaemia due to an increase in red cell destruction with no impairment of BM function

Question 2

True or false, HA is associated with the inability of the marrow to compensate for the increased red cell breakdown i.e. There is marrow failure.

Answer 2

False

Question 3

By how much can normal marrow increase in production rate

Answer 3

6-8 N

Question 4

What are the two sites of Haemolysis

Answer 4

Intravascular

Extravascular

Question 5

True or false, Most HA are extravascular, i.e in the spleen

Answer 5

True

Question 6

What is an exception of HA being acquired intrinsic

Answer 6

Paroxysmal nocturnal haemoglobinuria

Question 7

True or false, most intrinsic HA are congenital and most extrinsic ones are acquired

Answer 7

True

Question 8

What classification of HA is most useful clinically

Answer 8

Based on inheritance

Question 9

What are the two types of Membranopathies

Answer 9

Hereditary Spherocytosis

Hereditary Elliptocytosis

Question 10

What are the different types of Enzymopathies

Answer 10

Glycose 6- Phosphate dehydrogenase deficiency

Pyruvate kinase deficiency

Question 11

What are the different classifications of inherited/congenital HA

Answer 11

Membranopathies
Enzymopathies
Haemoglobinopathies

Question 12

What are he different types of Haemoglobinopathies

Answer 12

Sickle cell disease

Thalassemia

Question 13

What are the different types of Acquired HA

Answer 13

Immune

Non-Immune

Question 14

What are the different immune acquired HA

Answer 14

Autoimmune HA- idiopathic, secondary, drug induced
Incompatible blood transfusion
Haemolytic disease of the new born

Question 15

What are the different Non immune Acquired HA

Answer 15

MAHA (Microangiopathic haemolytic Anaemia)
Infections (malaria)
Chemicals/ drugs/ venom
Physical agents (thermal injury)
PNH

Question 16

What are the clinical features of congenital HA

Answer 16

Anaemia
Jaundice
Splenomegaly
Gall stones

Question 17

What are the different crisis in congenital HA

Answer 17

Aplastic , Haemolytic

Question 18

What disease is associated with Aplastic crisis

Answer 18

Parovirus B19 infection

Question 19

What is the MOA of parovirus B19 infection

Answer 19

Faeco- oral, oral-oral, respiratory

Question 20

Parovirus B19 infection decreases which two blood cells components

Answer 20

Haemoglobin, Reticulocyte

Question 21

How long does Parovirus B19 infection last

Answer 21

6-8 days

Question 22

What occurs in haemolytic crisis

Answer 22

Megaloblastic crisis
Splenomegaly
Cholelithiasis
Leg ulcers 
Skeletal abnormalities

Question 23

What deficiency causes megaloblastic crisis

Answer 23

Folate

Question 24

In cholelithiasis, is can be due to supersaturation of the bile with

Answer 24

Calcium bilirubinate

Question 25

What is stored in cholelithiasis

Answer 25

Black pigment

Question 26

What is expanded in skeletal abnormalities of congenital HA haemolytic crisis

Answer 26

Erythroid bone marrow

Question 27

What are some clinical features of acquired HA

Answer 27

Acute febrile illness Pallor and other features of Anaemia Jaundice

Question 28

What laboratory feature of Haem catabolism is identified

Answer 28

Unconjugated hyperbilirubinaemia | Increased urobilinogen

Question 29

What substance is increased as a laboratory feature of haemolytic Anaemia

Answer 29

Serum lactate dehydrogenase

Question 30

What substance is absent in the laboratory feature of haemolytic Anaemia

Answer 30

Haptoglobin

Question 31

What are signs of IV haemolysis in laboratory features of haemolytic Anaemia

Answer 31

``` Haemoglobinaemia Haemoglobinuria Haemosiderinuria Methaemalbuminaemia Reduced serum haemopexin ```

Question 32

What are the features of accelerated erythropoiesis

Answer 32

``` Reticulocytosis Macrocytosis NRBC in blood (nucleated red blood cells) Leucocytosis and thrombocytosis BM erythroid Hyperplasia ```

Question 33

What are the different tests to find the cause of HA

Answer 33

RBC morphology Antiglobulin test (Coombs test) Osmotic fragility

Question 34

``` What is associated with the prescence of: Spherocytes Elliptocytes Echinocytes Sickle cells Target cells Schistocytes Autoagglutination Heinz bodies ```

Answer 34

``` HS, AIHA HE PK def SCD Thal, HBC Disease MAHA Cold AIHA G6PD deficiency ```

Question 35

What are the symptoms of the differential diagnosis Anaemia and reticulocytosis

Answer 35

Bleeding Recovery from deficiency of iron/folate/B12 Recovery after marrow failure

Question 36

What are the symptoms of the differential diagnosis anaemia and acholuric jaundice

Answer 36

Ineffective erythropoiesis | Blood loss into body cavities/tissue

Question 37

What is treatments are used as a supportive measure

Answer 37

transfuse where appropriate splenectomy (sometimes) steroids (sometimes) folate supplementation

Question 38

What are the three differential diagnosis of HA

Answer 38

Anaemia + reticulocytosis Anaemia + Acohuric Jaundice Marrow Invasion