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What are examples of Alloimmune Hemolytic anemia? give all information
- Tranfusion reactions: ABO incompatibility
- patients have fever, chills, decreased blood pressure, hematuria
- can be very severe
- Hemolytic disease of the newborn: ABO and Rh incompatibility
- mom's antibodies attack fetus RBCs
- fetus develops hemolytic state with decreased RBC, hgb, hct, spherocytes
- erythroid hyperplasia in bone marrow results in plychromasia and NRBC
- treatment may be to exchange transfure infant
- *note- rhogam to mother as treatment
What are examples of Autoimmune Hemolytic anemia? give all information
- Warm-reacting antibodies (70-75%)
- IgG antibodies that react at >32C
- usually extravacular (no cell lysis) (destroyed my M0)
- positive Coombs test
- decreased hct; increased reticulocytes
- steroids usually given for treatment (slows M0 response)
- splenectomy sometimes necessary (prevents M0 action)
- Cold-reacting antibodies (15%)
- IgM antibodies that react at <30C
- usually intravascular (cell lysis)
- seen in patients with respiratory tract infections (pneumonia, TB)
- high titers to IgM which attach to cells in cold temperatures
- treatment is to avoid cold temperatures
- *note- cold causes agglutination of cells. warm sample for proper counting
What are examples of Drug induced hemolytic anemia?
- Antibodies stick to RBCs, which makes the RBC susceptable to lysis.
- Drug adsorption onto RBC membrane attracts antibodies
- Immune complex formation: formed by drug and antibody in plasma and complement is activated on RBC
- membrane modification: drug adsorption may cause non-specific protein adsorption onto the RBC surface
What are examples of non-immune hemolytic disorders?
- malaria, bacteria, viruses
- Mechanical trauma
- cardiac prosthesis - cells break when moving through improper valves
- march hemoglobinuria - red urine (name comes from military marching) (can be caused by wrong shoes while running)
- microangiopathic hemolytic anemia - red urine, decreased count (fibrin "spiderwebs" catch platelets and RBCs; may cause fragmentation)
What is paroxysmal nocturnal hemoglobinuria (PNH)? What tests?
- RBC membrane is very compliment-sensitive
- symptom: urine = bright red in AM (after zzz) due to pH increase during zzz)
- Ham's acidifed serum test: acid pH activates complement which lyses the cell
- Sugar water test: sucrose solution provides low ionic strength causing complement to bind to RBCs resulting in lysis
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