Macrocytosis does NOT rule out hemolytic anemia (HA) --> retics are larger than mature RBCs and may elevate MCV
Posted 12/28/16 09:19:54 AM by Matthew Cummings
Laboratory signs of hemolytic anemia
- Elevated LDH w/ reduced haptoglobin (<25) --> 90% specific for diagnosing hemolysis
- Normal LDH w/ normal haptoglobin (>25) --> 92% sensitivivity for ruling out hemolysis
Posted 12/28/16 09:25:25 AM by Matthew Cummings
Most urgent consideration when suspecting hemolytic anemia?
- Must also assess for TMA --> thrombocytopenia with schistocytes
- Consideration for empiric PLEX
Posted 12/28/16 09:26:48 AM by Matthew Cummings
Blood smear findings in auto-immune hemolytic anemia?
- Most commonly is NORMAL smear
- May see spherocytes (reduction in quantity of RBC membrane via macrophage-related destruction)
Posted 12/28/16 09:29:58 AM by Matthew Cummings
Hemolytic anemia and VTE
- VTE = very common cause of morbidity and mortality among patients with hemolytic anemias
- Immature RBCs = prothrombotic
- Despite low Hgb = must be on VTE ppx
Posted 12/28/16 09:31:53 AM by Matthew Cummings
- Direct: patient RBCs are washed and reacted with antiserum prepared against the various Igs
- Indrect: patient serum is incubated with normal RBCs
Posted 12/28/16 09:36:15 AM by Matthew Cummings
Warm auto-immune HA
- Agglutinates at 37C
- IgG (usually) targeting surface protein
- Associations: SLE, RA, hematologic malignancies, lymphoproliferative disorders, drugs, idiopathic
Posted 12/28/16 10:27:55 AM by Matthew Cummings
Cold agglutinins auto-immune HA
- Agglutinates at 30 C
- IgM(usually) targeting surface polysaccharide
- Associations: Mycoplasma, infectious mononucleosis, malignancies, lymphoproliferative disorders, idiopathic
Posted 12/28/16 10:28:39 AM by Matthew Cummings
Treatment of auto-immune HA
- Find and remove secondary causes (drugs typically cold agglutinins)
- Steroids -- may take 1-3 weeks to see improvement
- Splenectomy and Rituximab (2nd line if fail steroids)
- Transfuse -- often MUST transfuse PRBCs despite risk of transfusion reaction
- Note: Warm typically steroid-responsive, Cold often steroid resistant
Posted 12/28/16 10:42:31 AM by Matthew Cummings
For further reading...
Posted 12/28/16 10:43:38 AM by Matthew Cummings
Created by Christopher Kelly
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