1. HEMOLYTIC ANEMIAS

2. LEARNING OBJECTIVE
1. To compare and contrast intravascular and extravascular hemolysis 2. To acquire basic knowledge about the tests which are indicative of increased red cell destruction; increased red cell production 3. To emphasize on the peripheral and bone marrow changes seen in response to excessive red cell destruction

3. TYPES OF HAEMOLYSIS
Intravascular haemolysis Extravascular haemolysis

5. INTRAVASCULAR HAEMOLYSIS
- Mismatched blood Transfusion
- Drug induced
- Disseminated Intravascular Coagulation (DIC)
- Paroxysmal nocturnal haemoglobinuria (PNH)
- G 6-PD deficiency

8. EXTRAVASCULAR HAEMOLYSIS
- Membrane defects (HS)
- Immune haemolytic anaemia
- Thalassaemia syndrome

9. LABORATORY TESTS FOR INCREASED RED BLOOD CELL DESTRUCTION
EXTRAVASCULAR RED CELL DESTRUCTION
Serum bilirubin - increased
Serum heptoglobin - decreased
Serum LDH - increased
Increased urinary and fecal urobilinogen
Bone marrow iron - increased

10. LABORATORY TESTS FOR INCREASED RED BLOOD CELL DESTRUCTION CONTD…
INTRAVASCULAR RED CELL DESTRUCTION
Serum bilirubin - increased
Serum heptoglobin - decreased
Serum LDH - Increased
urinary and fecal urobilinogen
Hemoglobinaemia and hemoglobinuria
Methaemalbuminaemia
Urinalysis - Hemosiderinuria
Bone marrow iron stores - Decreased

11. LABORATORY TESTS FOR INCREASED RED BLOOD CELL PRODUCTION
Reticulocytosis
Bone marrow - Increased erythropoeisis
Serum folate - decreased

12. LABORATORY FEATURES (MORPHOLOGICAL)
SPECIALIZED TESTS:
1. SUPRA-VITAL STAIN
- Reticulocytosis
- Hb-H inclusions
- Heinz bodies
2. COOMB’S TEST
- Direct ( Antibody-coated red cells)
- Indirect ( Serum antibodies)

13. LABORATORY FEATURES (MORPHOLOGICAL) CONTD..
3. Osmotic fragility
- Hereditary spherocytosis
4. G-6PD deficiency screening test
5. Hb-Electrophoresis
- Thalassaemia syndromes

14. LABORATORY FEATURES (MORPHOLOGICAL)
A. PERIPHERAL BLOOD FILM
- Anisocytosis
- Poikilocytosis
- Polychromasia
- Target cells
- Schistocytosis(fragmented RBC,s)
- Spherocytosis
- Reticulocytosis

15. LABORATORY FEATURES (MORPHOLOGICAL) CONTD..
- Helmet cells
- Bitten cells, triangle cells
- Red cells inclusions:
Heinz bodies
Howell Jolly(H.J) bodies

23. LABORATORY FEATURES (MORPHOLOGICAL) CONTD..
B – BONE MARROW FINDINGS
- Hypercellular
- Erythroid hyperplasia
- Megaloblastoid changes
- Bone marrow – incresaed iron