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Normal life span of rbc is 120 days Premature destruction Increase in reticulocyte index Intravascular hemolysis Free Hb binds to haptoglobin Hemoglobinuria,hemoiderinuria Haptoglobin levels are reduced Extravascular hemolysis by liver and spleen Megaloblastosis due to folate deficiency Compensated and decompensated hemolysis
HEREDITARY SPHEROCYTOSIS : inherited as autosomal dominant 25% cases have no family history Common are deficiency of betaspectrin or
ankyrin
INVESTIGATIONS : CBC spherocytes Direct coombs test negative Osmotic fragility test sensitivity to lysis in hypotonic solution Flow cytometry binding of eosin 5- maleimide to rbc TREATEMENT : Folic acid supplement Spleenectomy Transfusion
HEREDITARY ELLIPTOCYTOSIS :
The G6PD gene located on x chromosome Pivotal in HMP shunt Produces NADPH to protect RBC cells Affects males
CLINICAL FEATURES : Precipitating factors : antimalarials chronic compensated state favism ( toxin present in weeds ) acute illness INVESTIGATIONS : CBC : elliptic rbc cells G6PD levels TREATEMENT :-
a. idiopathic b. lymphomas c. SLE and other collagen vascular diseases d. Drugs methyl dopa type Penicillin type Quindine type e. post viral infections INVESTIGATIONS : blood smear hemolysis , reticulocytosis direct coombs test TREATEMENT : treating the cause prednisone transfusion spleenectomy immunosuppression
COLD AIHA :
active at lower body temperature IgM antibodies Elderly persons Underlying lymphoma Donath Landsteiner antibody Mycoplasma
cell level Inactivating somatic mutation in a single hematopoietic stem cell of a gene on the x chromosome (pig-A) for GPI Absence of CD55 and CD59 Complement mediated hemolysis CLINICAL FEATURES : Haemolytic anemia Venous thrombosis Deficient hematopoiesis INVESTIGATIONS : Evidence of intravascular hemolysis , hemogolinemia, elevated LDH, hemosidenuria Leukopenia Thrombocytopenia Acidified serum lysis test Sucrose lysis test Flow cytometry TREATEMENT : Transfusion Glucocorticoids Acute thrombosis anticoagulants Marrow transplantation
hypoplasia
a. aplastic anemia b. myelodysplasia : normal stem cell to abnormal premalignant cells leading to acute leukaemia c. myelophthisis : bone marrow is normal and there is infilteration of other cells. Pancytopenia occurs d. pure red cell aplasia pancytopenia anemia leukopenia thrombocytopenia aplastic anemia pancytopenia and bone marrow hypocellularity ETIOLOGY radiation acute sequela chemicals benzene drugs a. dose dependent cancer chemotherapy alkylating aents, antimetabolites
idiosyncratic
a.
chloraphenicol , NSAIDS (long standing osteoarthritis) b. anticonvulsants, sulfanamides a. hepatitis b. infectious mononucleosis EBV
infections
c. parvovirus B19
immunologic disorders
CLINICAL FEATURES : onset a. abrupt b. insidious bleeding most common early symptom anemia symptoms infection history of drug intake, chemical exposure or preceding viral illness lymphadenopathy,splenomagaly absent
LAB STUDIES : peripheral smear bone marrow a. aspiration b. biopsy hematopoietic cells< 25% of marrow space TREATMENT : bonemarrow transplantation young patient with fully histocompatible sibling donor restrict transfusion
immunosuppression
a. anti lymphocyte globulin b. anti thymocyte globulin c. cyclosporine a. antibiotics b. transfusion support
supportive therapy
usually cellular bone marrow ineffective blood cell production occurs in elderly persons more in males CLASSIFICATION : refractory anemia (RA) refractory anemia with ringed sideroblasts(RARS) refractory cytopenia with multilineage dysplasia (RCMD) refractory anemia with excess blasts 1 (RAEB 1 and 2) myelodysplastic syndrome, unclassified MDS with isolated del (5q) ETIOLOGY : Radiation Benzene Alkylating agents such as busulfan, nitrosourea or procarbazine Cytogenetic abnormalities aneuploidy CLINICAL FEATURES :-
(febrile neutrophilic
dermatosis) LAB STUDIES :BLOOD Anemia Bi or pancytopenia Isolated neutropenia or thrombocytopenia Macrocytosis is commom May be dimorphic BONE MARROW Usually normal or hypercellular Dyserythropoietic changes and ringed sideroblasts Hypogranulation and hyposegmentation in granulocytic precursors Increase in myeloblasts Vitamin B12 or folate-normal Rule out viral infections, drug reaction and chemical intoxicity TREATMENT : Unsatisfactory Stem cell transplantation cure 5 azacytidine inhibits DNA methylation G-CSF Supportive care