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  1. 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
  2. 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
    • microspherocytes
    • 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
  3. 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
  4. What are examples of non-immune hemolytic disorders?
    • Infections
    • 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)
  5. 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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