Bleeding complications - Hemolytic anemia

7 important questions on Bleeding complications - Hemolytic anemia

Name 3 immunological and 3 non-immunological (hereditary) causes of hemolysis.

Immunological:
  • auto-immune: warm or cold
  • Allo-immune
  • vitamin B12 or folic acid deficiency

Non-immunological:
  • sickle cell disease
  • paroxysmal nocturnal  hemoglobinuria
  • G6PD deficiency

What is the first treatment options for auto-immuun hemolytic anemia?

Prednison

What is the mechanism of paroxysmal nocturnal hemoglobinuria?

Red blood cells are broken down more quickly then necessary. The GPI anchors are absent and that are enzymes that prevent RBC break down.
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What are the complications of PNH?

  • Hemolysis
  • thrombosis
  • bone marrow failure
  • underlying bone marrow disease

What are the consequences of the baby when the mother is pregnant and has PNH? How do you treat this in a pregnant women.

The baby will have a growth restriction. The mother has an anemia, which leads to less Hb and oxygen for the baby to growth.

You treat this with emicizumab.

What are the most common anti-immune hemolytic anemias (AIHA)?

  • Cold: cold acra. Mostly due to IgM antibodies
  • Warm: hemolyse with temperature > 37 degrees. 

What are the treatment option for a warm AIHA?

  • Transfusion
  • Inhibition autoAb production: corticosteroids, immunosuppressives, Rituximab (CD20), Dazazol
  • Inhibition RBC clearance: IVIG (intravenous immunglobulines), splenectomy
  • Treatment underlying disease

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