Hematology: Non-Immune Hemolytic Anemia

*acquired* extracorpuscular defects which shorten the life of the normal RBC

non-immune hemolytic anemia

What 4 organisms can cause hemolytic anemia?

malaria, Babeisa, Bartonella bacilliformis, Clostridium perfringens

What 4 chemicals can cause hemolytic anemia?

arsenic, lead, copper, venoms

What is the vector for Malaria?

female Anopheles mosquito

What are the S/S of Malaria?

fever, chills, prostration, hemoglobinuria (Black water fever)

What are the lab findings in malaria?

malarial parasites in the red cells, leukopenia and thrombocytopenia (due to pancytopenia), hemoglobinuria, normo normo, decreased hct

What is the vector of Babesiosis?

infected tick

What are the S/S of Babesiosis?

flu-like illness with night sweats and fever

What are the lab findings of Babesiosis?

Maltese cross on peripheral smear

What is the therapy for Babesiosis?

clindamycin and quinine

caused by a gram negative plemorphic bacillus; disease is known as Oroya fever or Carrion's disease

Bartonella bacilliformis

What is the vector for Bartonella bacilliformis infection?

sand fly (Phlebotomist verrucurum)

What are the S/S of Bartonella bacilliformis infection?

starts out with flu-like symptoms, progresses to skin lesions then a secondary stage with warty tumors and lymphadenopathy

What are the lab findings of a Bartonella bacilliformis infection?

appears as purple rods, filaments or coccoid bodies attached to the surface of the RBC

What is the therapy for a Bartonella bacilliformis infection?

antibiotics

GPB organism that produces alpha toxins which attack the red cell membrane to produce severe hemolysis

Clostridium perfringens

What do the alpha toxin in Clostridium perfringens do to the red cell and tissues?

attach red cell membrane and hemolyze it

cause deep tissue damage, need poured antibiotic

What are the S/S of Clostridium perfringens?

gas gangrene, sepsis

What are the lab findings of Clostridium perfringens?

normo normo, occ microspherocyte, hemolglobinuria from increased serum hemoglobin

What is the therapy for Clostridium perfringens?

debridement of the wound, antibiotics poured in wound

In Malaria, what is the name of the dots and rings characteristically noted in Plasmodium faciparum?

signet ring with Scheuffner's dots

How do you differentiate Babesia from Malaria?

Babesia presents with the Maltese cross on the RBC, malaria has rings

the ability of some microorganisms to alter their morphology, biological functions, or reproductive modes in response to their environmental conditions; in the case of Bartonella bacilliformis, it is the variable shape (rods, filaments, coccoid bodies)

pleomorphic

lymph nodes are overworked and become swollen

lymphadenopathy

What is the main problem for a patient with Clostridium perfringens that can lead to death?

sepsis

What happens to haptoglobin levels in cases of hemolytic anemia?

haptoglobin levels *decrease* in hemolytic anemia because when red cells are hemolysed, they release hemoglobin, so haptoglobin tries to bind to all of the free hemoglobin

How does lead interfere with hemoglobin?

blood likes to hang on to lead instead of binding to oxygen or iron or hgb; also interrupts the hemoglobin synthesis pathway

What RBC morphologies would you expect to see in lead poisoning?

coarse basophilic stippling, Cabot rings, ringed sideroblasts in bone marrow, micro hypo

What are the S/S of lead poisoning (aka Plumbism)?

anorexia, anemia, pica, sporadic vomiting, clumsiness, poor motor skills, convulsions, cerebral degeneration

How does copper lyse RBCs?

copper inhibits reducing enzyme systems and the glycolytic pathway of the red cell membrane, causing it to lyse

How can people be exposed to copper?

excessive intake (ingestion, leached from pipes and pans)

exposure to hemodialysis solutions contaminated by copper

ingestion of copper sulfate solutions (suicide attempts)

In what scenarios can water cause hemolysis?

ingest mass amounts of water or drowning

leads to osmotic damage and lysis of cells

What is the difference between microangiopathic and macroangiopathic?

microangiopathic: affect small blood vessels such as capillaries (TTP, HUS, DIC)

macroangiopathic: affect large blood vessels such as arteries, heart

How does TTP cause bleeding?

Precapillary arterioles of the brain, kidney, heart, adrenals and pancreas become occluded by platelet aggregates and fibrin. Blood cannot flow through the clots, so it shreds.

What are the S/S of TTP?

headache, seizures, coma (no O2 to brain)

possible renal dysfunction (proteinuria, hematuria)

*multi-organ* failure

How is DIC similar to TTP?

both are abnormal clotting in blood vessels, but DIC affects BOTH small and large vessels

reduce inflammation and suppress the immune system; used in TTP treatment

corticosteroids

How does FFP work for TTP therapy?

FFP would provide normal clotting factors to replace the dysfunctional ones and promote proper clotting

What usually causes HUS?

toxin produced by a virulent E. coli (O157H7) acquired via undercooked meat

What is the main organ involved in HUS?

Kidneys are usually the only organ involved because the virulent E. coli is specific to kidneys. It can cause *irreversible* kidney damage within 24 hours.

What are the S/S of HUS?

acute, febrile illness with nausea and vomiting followed by renal dysfunction, renal failure, hypertension

What are the lab findings of HUS?

*Burr cells*, increased BUN:creatinine; RBC, granular, and hyaline casts in UA, schistocytes

blood clots that form inside blood vessels, causing blockages and disrupting blood flow

intravascular thrombi

protease that is crucial in breaking down von Wildebrand factor; deficient in TTP

ADAMSTS13

trauma which activates the coagulation system leading to intravascular generation of thrombin

disseminated intravascular coagulation (DIC)

How causes DIC (MOST)?

*M*alignancy

*O*bstretic complications

*S*epticimia

*T*rauma

What is the purpose of using heparin for therapy in DIC? What additional factor does heparin need to work?

heparin will maintain blood volume

needs antithrombin III in order to work

changes in blood lipid concentration, causing abnormalities in the red cells membrane lipid composition

lipid disorders

What is the peripheral blood smear in lipid disorders?

acanthocytes (irregular projections)

What condition of the liver can cause hemolysis?

cirrhosis

a mild hemolytic disorder that occurs with repetitive traumatic stress exerted to the palms of the hands and soles of the feet

march hemoglobinuria

red cell survival is shortened by an enlarged spleen

hypersplenism

What does venom do to blood? What condition is it similar to?

similar to DIC in that poisons activate clotting factors and use them up

Why are children more susceptible than adults to bacteria?

they are smaller, so it takes less of a bacterial load to get them sick

What is the RBC morphology related to renal disease?

Burr cells