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Warm Antibody Autoimmune Hemolytic Anemia 1) DIAGNOSE AIHA • Anemia: macrocytic > normocytic, ↑ reticulocytes •
Antibody Autoimmune Hemolytic ... normocytic, ↑ reticulocytes ... • Hemolysis: ... type ± C3d • Blood ... Antibody #Autoimmune #Hemolytic
Anemia Diagnostic Algorithm Mean corpuscular (cell) volume (MCV): Average RBC size. Under 80 = microcytic. Between 80-95
Reticulocyte count ... in peripheral blood ... High in acute blood ... loss, hemolysis ... Corrected reticulocyte
Reticulocyte Production Index = (Retic %) x (Hct / 45) / Maturation Factor The maturation factor is
Reticulocyte Production ... the peripheral blood ... > 3: • Acute blood ... Retroperitoneal, Uterine • Hemolysis ... Microangiopathic hemolytic
Algorithm for the evaluation of macrocytic anemia. (RBC = red blood cell; MMA = methylmalonic acid.) Physicians
(RBC = red blood ... peripheral smear, a reticulocyte ... specifically order a reticulocyte ... Hemorrhage or hemolysis ... elevation in the reticulocyte
Hemolysis - Differential Diagnosis Framework 1) Environment - Fragmentation - MAHA: TTP, HUS, DIC, HELLP
Hemolysis - Differential ... - Peripheral Blood ... abnormal RBCs - Reticulocyte ... Urobilinogen #Hemolysis
Red Blood Cell (RBC) Morphology Atlas • Microcytic - Iron-deficiency anemia, Thalassemia, Sideroblastic anemia, Lead poisoning
Red Blood Cell ( ... syndrome, Increased reticulocyte ... spherocytosis, Hemolytic ... Schistocytes - Hemolytic
Laboratory Testing in Hemolytic Anemia Intravascular vs Extravascular Hemolysis Reticulocytes Unconjugated bilirubin LDH Peripheral smear Haptoglobin Urine hemosiderin Urine hemoglobin Carboxyhemoglobin #Hemolytic #Anemia #Laboratory #Testing #workup
Laboratory Testing in Hemolytic ... Extravascular Hemolysis ... Reticulocytes ... Carboxyhemoglobin #Hemolytic ... diagnosis #hematology #hemolysis
Hemolytic Anemias - Differential Diagnosis Algorithm Signs of anemia and hemolysis: • ↓ Haptoglobin • ↑ LDH
Hemolytic Anemias ... of anemia and hemolysis ... bilirubin • ↑ Reticulocytes ... Immune-mediated Hemolysis ... • Autoimmune Hemolytic
Calculating a Reticulocyte Index (RI) Reticulocyte Index = Absolute Reticulocyte Count / Maturation Correction Absolute Reticulocyte Count =
Calculating a Reticulocyte ... Index (RI) Reticulocyte ... Index = Absolute Reticulocyte ... Count = % of reticulocytes ... SatyaPatelMD #Reticulocyte
Pancytopenia - Differential Diagnosis Algorithm • 12-13 g/dL, • ANC < 1800/uL, • platelet < 150,000/uL Initial
peripheral smear, reticulocyte ... Production (↓ reticulocytes ... ↑ Destruction (hemolysis ... , ↑ reticulocytes
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