Hemolytic Anemia – Bleeding

Hemolytic Anemia

Skull bone deformities in thalassemia:

• Appearance changes: round face, large head, prominent forehead, boney bump on the top of the head, flat nasal bridge.

• X-ray: thick skull, hair-on-end appearance, osteopenia.

Laboratory findings:

• Blood test:

• Demonstrates rapid red blood cell destruction, increased hemoglobin degradation.

• Decreased red blood cells, hemoglobin.

• Free blood bilirubin > 0.6 mg/dl.

• Decreased haptoglobin.

• Increased LDH.

• Normal or increased serum iron.

• Red blood cell half-life of 7-15 days.

• Contextual test: increased erythropoiesis.

• Peripheral blood: increased reticulocytes, many young red blood cells.

• Bone marrow: increased erythroid line, increased percentage of reticulocytes in the marrow.

Indications for splenectomy in autoimmune hemolytic anemia:

• Multiple severe hemolytic episodes.

• Corticosteroid therapy is ineffective for 6 months.

Indications for splenectomy in thalassemia:

• When there is secondary hypersplenism.

• Increased blood transfusion needs.

• Presence of small gastric red blood cells due to enlarged spleen.

Bleeding

Classification of 4 bleeding levels:

1. Level 1: Mild bleeding, petechiae, purpura.

2. Level 2: Moderate bleeding, ecchymosis, hematoma.

3. Level 3: Severe bleeding, heavy bleeding, internal bleeding.

4. Level 4: Extremely severe bleeding, life-threatening.

Clinical signs guiding diagnosis of bleeding:

• Bleeding pattern: External, internal.

• Morphology: Petechiae, purpura, ecchymosis, hematoma, hemorrhage.

• Location: Skin, mucous membranes, internal organs.

• Bleeding: Blood volume, bleeding rate.

• Coagulation: Prothrombin time, coagulation ability.

• Platelets: Platelet count, platelet function.

• Tourniquet test: Positive or negative result.

Approaching diagnosis of anemia based on:

• Bleeding time: Prolonged bleeding time.

• PT: Prolonged PT.

• APTT: Prolonged APTT.

Laboratory findings:

• Prolonged bleeding time: Medications, high blood urea, Von Willebrand disease, platelet dysfunction.

• Prolonged PT: Factor VII deficiency, liver disease, Vitamin K deficiency.

• Prolonged APTT: Hemophilia A, B, Von Willebrand disease, Lupus, heparin.

• Prolonged PT, APTT: DIC, liver disease, Vitamin K deficiency, heparin.

Medications causing platelet dysfunction:

• Penicillin, Tetracycline, cardiovascular medications, lipid-lowering medications.

Causes of decreased platelet count:

• Peripheral:

• Platelet destruction: autoimmune disease, medications, infection.

• Increased platelet consumption: DIC, gastrointestinal bleeding.

• Bone marrow:

• Decreased platelet production: bone marrow failure, cancer.

• Hereditary:

• Wiskott-Aldrich syndrome.

• Bernard-Soulier syndrome.

Combined causes of bleeding:

• Von Willebrand disease.

• Liver, kidney disease.

• Cancer.

• Hematologic malignancies.

Petechiae, purpura:

• Petechiae: < 3 mm.

• Purpura: 3-10 mm.

Positive tourniquet test:

• > 10 purpura / 10 cm2.

Factors related to Schonlein-Henoch purpura:

• Weather: Winter and spring.

• Parasites: Roundworm.

• Infection: Tuberculosis, respiratory tract infection.

• Vaccination: Diphtheria, tetanus.

• Allergies: Food, house dust.

Characteristics of Schonlein-Henoch purpura:

• Occurs in 95-100% of cases.

• Appears spontaneously, in episodes, in the same age group.

• Morphology: petechiae, purpura, papules, nodules.

• Symmetrical on limbs.

Clinical manifestations of Schonlein-Henoch purpura:

1. Purpura.

2. Gastrointestinal: Abdominal pain, vomiting, hematochezia.

3. Arthritis.

4. Nephritis.

Laboratory findings of Schonlein-Henoch purpura:

• Normal coagulation tests.

• CBC: Increased BCTT, increased acidophilic.

• Increased ESR.

ITP

Progression of ITP:

• 90% complete remission within 6 months.

• 10% become chronic:

• Risk factors: female, over 10 years old, slow onset, presence of other autoantibodies.

Progression according to ITP association:

• Acute: Disease diagnosed < 3 months.

• Prolonged: 3-12 months, treated or untreated.

• Chronic: > 12 months.

• Severe: New bleeding symptoms requiring treatment, or new bleeding locations requiring increased dosage.

Differential diagnosis of ITP:

• Bone marrow failure.

• Bone marrow disorders.

• Cancer.

• Lupus.

Indications for splenectomy in ITP:

• Treatment for more than 1 year.

• Age over 5.

• Recurrent severe bleeding.

Hemophilia

Treatment products for Hemophilia:

• Synthetic factor VIII/IX.

• Cryoprecipitate VIII.

• Fresh frozen plasma.

Hemophilia treatment dosage in each case:

• Joint, skin, muscle, mouth bleeding:

• Factor VIII: 20-25 units/kg/12 hours.

• Factor IX: 30 units/kg/24 hours.

• Continue treatment until bleeding stops.

• Severe bleeding: gastrointestinal, intracranial, surgical:

• Factor VIII: 50 units/kg every 12 hours x 3 days.

• Factor IX: 70 units/kg/12 hours x 3 days.

• Then every 24 hours for 7 days.

Prophylaxis of recurrent bleeding in Hemophilia:

• Regular factor VIII, IX infusion.

• Avoid any trauma.

• Avoid medications affecting platelet function.

• Maintain joints in functional position, combine with rehabilitation therapy.

• Monitor and prevent blood-borne diseases.

Bleeding due to Vitamin K deficiency

Treatment of bleeding due to Vitamin K deficiency:

• Inject Vitamin K 2-5 mg/day.

• Transfuse fresh frozen plasma for severe bleeding.

Prophylaxis of bleeding due to Vitamin K deficiency:

• Inject 1 mg Vitamin K1 for newborn babies.

Note: This article is for informational purposes only and cannot replace the advice of a doctor. Please consult a doctor for appropriate diagnosis and treatment.