溶血性贫血的介绍.ppt

Anemias of Effective Erythropoiesis: Module Objectives
Explain the physiologic theory relevant to the test/procedure fosmear RBC polychromasia
Morphology
Pathophysiology
Clinical
Relevance
Red Blood Cell MorphologyInter-relationship Triad
Morphology in HA
Morphology specific to the type of HA may be present, ., spherocytes, elliptocytes and stomatocytes
Secondary Laboratory Investigation
Decisions about what procedures to use for secondary, or follow-up, investigation are based on the findings of the hemogram and morphology
Secondary Laboratory Investigation
Chemistry
Bilirubin: Increased unconjugated bilirubin is indicative of hemolysis
Secondary Laboratory Investigation
Chemistry, continued
Haptoglobin
Carries free plasma globin
Decreased levels are indicative of hemolysis
May be increased in inflammation masking hemolysis
Secondary Laboratory Investigation
Chemistry, continued
Increased free plasma hemoglobin
Increased lactic dehydrogenase
Urinalysis
Hemoglobinuria or methemoglobinuria
Hemosiderinuria
Urobilinogen
Survey of HA by Type
Hereditary
Acquired
Hereditary HA
Membrane abnormalities
Enzymopathies
Plasma constituent abnormalities
RBC Membrane Structure
+
+
Plasma
IntegralProteins
Peripheral Proteins
Lipid Bi-Layer
—
—
Lipid Bi-Layer
RBC Cytoplasm
Membrane Abnormalities
Spherocytosis
Elliptocytosis
Pyropoikilocytosis
Stomatocytosis
Membrane Abnormalities
See figure 17-1
Excess membrane cholesterol
RBC inclusions
Senescent RBC
Complement coated RBC
Antibody coated RBC
Rigid RBC
Spleen: Effects on RBCs
Hereditary Spherocytosis
Defect: RBC protein defects affecting spectrin
Pathophysiology
Increased Na+ permeability 
RBC rigidity 
Destruction in spleen
Testing: Increased osmotic fragility
Incubated osmotic fragility
Hereditary Spherocytosis
See figures 17-2 and 3
Sp