Acquired Hemolytic Anemia
(Internal Disease - Circulatory)
Acute Acquired Hemolytic Anemia
Etiology and pathogenesis. Arise as a result of infections (sepsis, malaria, etc.), intoxications hemolytic poisons (phosphorus, phenylhydrazine, or mushroom, snake venom, etc.), physical factors (cooling, burns). Increased hemolysis arises from the direct effects on red blood cells of the pathogenic factor and as a result of the influence of exogenous factors that lead to the formation of anti-erythrocyte antibodies in the application of certain medicinal substances. Thus, the use of Amidopyrine, Quinine, sulfanilamide and other drugs can lead to the formation of autoantibodies. As a result, connecting them with proteins and blood cells, these substances are autoantigens, causing the formation of antibodies to its own blood cells, including the red cells (heat and cold haemagglutinins, hemolysins, and other antibodies). Autoimmune hemolytic anemia are also observed in collagen disease, malignant tumors, leukemia, chlamydia, etc.
These anemia also arise when incompatible blood transfusion in the group and Rh factor. In such cases, hemolysis develops as a result of isoimmune antibodies that react with transfused red cells.
The presence in serum of patients with red cell antibody positivity recorded Coombs.
Symptoms and flow. The disease is characterized by acute onset. Chills, fever (up to 39-40В°), severe weakness, sometimes dyspeptic symptoms, the yellowness of the skin and visible mucous membranes. Since the cardiovascular system, expansion of the borders of the heart, tachycardia, systolic murmur, hypotension. In severe cases, collapse. In the blood revealed normocytic anemia or macrocytic type, normoeritro-blastosis, increased reticulocytosis, the shift of the blood to the left, increased the number of indirect bilirubin. Spleen and liver increased. The urine protein appears and free hemoglobin, resulting in urine becomes black. In some cases, a picture of thrombosis kidney pigments of red blood cells and debris from the development of severe necrotic changes, leading to anuria and azotemia.
In bone marrow erythroblast sharp reaction.
Recognition is based on progress of acute hemolytic anemia type, the presence of erythroblastic reaction in the bone marrow. The immune form of acute hemolytic anemia, Coombs’ positive test is confirmed. Acute hemolytic anemia in some cases have to differentiate with erythroleukemia. In favor of hemolytic anemia by the absence of gemotsitoblastnoy hyperplasia and higher reticulocytosis.
Treatment. The best effect was given with steroid hormones used in middle and high doses (30-60 mg daily) in combination with blood transfusions. When you take into account the hormonal preparation of the patient. At inclinations to violate water-salt metabolism is useful to apply triamsinolon and dexamethasone, in disorders of nitrogen metabolism and osteoporosis - prednisone or prednisolone. In acute and massive hemolysis, which is comparable with the action of corticosteroid therapy, shown splenectomy.
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