Acquired Hemolytic Anemias

DR. Sana D. Jalal

Immune Hemolytic anemia

Autoimmune Alloimmune Drugs

Warm Cold Hemolytic Transfusion reaction

Hemolytic Disease of the Newborn

Etiology of Warm AIHA

1.1. Idiopathic :Idiopathic : (in about one third of cases)

2. 2. Secondary:Secondary: in association with other disorders including autoimmune disorders, lymphomas and some drugs like aldomet.

auto-antibody best reacts with red cells at 37C, IgG class, usually associated with extravascular hemolysis.

Clinical Features of Warm AIHA

• Usually with insidious onset of pallor and jaundice with splenomegaly .

• Signs and symptoms of SLE, lymphoma or history of drug intake due to hypertension.(secondary cases).

Blood Picture in warm AIHA

Variable anemia, normochromic, spherocytes and micro-spherocytes with polychromasia

• Most important is the Direct Coomb’s TestDirect Coomb’s Test, and if positive, it is of diagnostic value.

Cold Autoimmune HA

• Cold AIHA may be

1. Idiopathic.

2. Secondary : in association with lymphomas and certain infections like Mycoplasma pneumoniae.

autoantibody reacts best with RBC in the cold at 4C, IgM class, with the capacity to intravascular lysis.

Clinical Features of cold AIHA:

• In most idiopathic cases the patients have persistent pallor with or without jaundice.

• Alternatively patients may have episodes of hemoglobinuria, induced by chilling or a combination of these two patterns may also occur.

• Cold mediated vaso-occlusion phenomena like acrocyanosis may be encountered.

• Splenomegaly is commonly encountered.

Blood film in cold AIHA

Direct Coomb’s testDirect Coomb’s test is classically positive.Detection of significant cold antibodies by the cold agglutinin titre tests.

•Aplastic Anemia

Definition

• Pancytopenia in the blood and a hypocellular marrow in which normal haemopoietic elements are replaced by fat cells.

• Abnormal cells are not present in the peripheral blood or bone marrow.

Etiology

Idiopathic Drugs related Irradiation Infective agents

> 2/3 of cases

a.Cytotoxic drugs.

b.Other drugs Chloramph-enicol, Benzene, sulphonamide

Hepatitis, HIV, EBVirus etc.

Clinical Manifestations

1.Bleeding tendency, Purpura , mucous membrane bleeding, e,g epistaxis, GI blood loss , bleeding per vagina.

2. Tiredness.

3. Infections.

4. No jaundice.

5. No organomegaly.

Blood Picture

• Pancytopenia ( reduction in Red cells (HB), WBC, and Platelets).

• CBP Findings :

Red cells : normochromic, usually macrocytic, with reduced retics.

Red cell indices : MCV usually increased, MCH and MCHC usually normal.

Bone Marrow Findings

Anemia of Chronic Disease

• Chronic infection, inflammation or malignancy– TB, lung abscess, HIV– RA, SLE, or other autoimmune dz– Malignancy

• Release of inflammatory cytokines suppresses erythropoiesis

• Hallmarks—low serum iron, low TIBC/transferrin, normal/increased ferritin

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