Last week we had a #haemSpR training day. First up haemolytic anaemia.
Comprehensive BSH guidelines here
b-s-h.org.uk/guidelines/gui…
and here
b-s-h.org.uk/guidelines/gui…
Can the #haemSpRs tell me what a DAT is and what it means?
haemolysis screen = hb, film, bili, haptoglobin, LDH, DAT. Haptoglobin =protein to mop up toxic free haem. also an acute phase reactant
First question in immune haemolysis: is it warm, cold or mixed? Will determine further ix AND treatment.
Cause of AIHA must be determined. Think infection, cancer (not just LPD) and autoimmune disease
Small print =check lymphocyte subsets if Evans syndrome and in children ??ALPS
What is ALPS? (were the #haemSpRs listening?)
Can the #haemSpRs tell us what Evans syndrome is?
Steroids, splenectomy or ritux really the only treatments that work in warm AIHA. IVIg as rescue therapy.
Donath Landsteiner test is for PCH diagnosis. Control sample has same components but kept at 37 degrees; test sample cooled and warmed
Some good bedtime reading for #haemSpRs here hospital.blood.co.uk/media/28142/sp…
Erythrophagocytosis may be seen on blood film in PCH (a gift in the FRCPath if seen... it has been known...)
Rx of PCH is supportive. Transfusion is with ABO/rh/kell compatible blood but not P negative
Top up transfusion in sickle:
Full Rh/kell match (w baseline extended phenotype sent)
HbS neg
<10 days old
b-s-h.org.uk/guidelines/gui…
In hyperhaemolysis DAT may be neg and retics low. Cardinal feature is lysis to haemoglobin lower than pre transfusn (bystander haemolysis)
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