09 Extrinsic Hemolysis
![](https://photos.thisispiggy.com/file/wikiFiles/2QvpcwI.jpg)
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AIHA
![](https://photos.thisispiggy.com/file/wikiFiles/GX6Ad2R.jpg)
- antibodies coat RBC. RBC removed in spleen
- RBC protect themselves from complement activation: no intravascular hemolysis
Warm
Pathogenesis and Symptoms
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![](https://photos.thisispiggy.com/file/wikiFiles/ECUMrFe.jpg)
- classic symptoms of anemia
- splenomegaly: macrophages hypertrophy to consume RBCs
Diagnosis
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- smaller, spherical, lack central pallor
- macrophage can't engulf whole RBC, just takes a bite off of it: shrink in size, more dense
- also inherited disease
![](https://photos.thisispiggy.com/file/wikiFiles/6TvUiok.jpg)
- first see if normocytic anemia, then if RC is increased (increased production), then DAT
![](https://photos.thisispiggy.com/file/wikiFiles/bLgQEGz.jpg)
- anti IgG antibodies bind to IgG on RBC and cause them to agglutinate
![](https://photos.thisispiggy.com/file/wikiFiles/LR0SdIj.jpg)
- not used for AIHA
- take patient serum and add sample RBC. Positive if antibodies in patient serum to RBC
![](https://photos.thisispiggy.com/file/wikiFiles/AahK8GR.jpg)
- used for new born hemolytic disease with mother serum against D+ RBC
![](https://photos.thisispiggy.com/file/wikiFiles/dsrdfkD.jpg)
Causes
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- all these diseases involve immune system
![](https://photos.thisispiggy.com/file/wikiFiles/Wrjv2FN.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/0VVl3K1.jpg)
- RBC bind antibody in absence of drug: surface of RBC altered
![](https://photos.thisispiggy.com/file/wikiFiles/q1vzhy9.jpg)
Treatment
![](https://photos.thisispiggy.com/file/wikiFiles/sKlRUky.jpg)
Cold
![](https://photos.thisispiggy.com/file/wikiFiles/waoFbT5.jpg)
- symptoms of anemia plus symptoms in extremities
![](https://photos.thisispiggy.com/file/wikiFiles/0LrNXp2.jpg)
- large antibodies, cause RBC to agglutinate, especially in extremities
- IgM fix complement, leaves bound C3 on RBC
- DAT positive not for IgG but only for C3
![](https://photos.thisispiggy.com/file/wikiFiles/yHncFQh.jpg)
- C3 doesn't get in the way of macrophages like IgG: engulf whole
- intravascular hemolysis result of complement activation
![](https://photos.thisispiggy.com/file/wikiFiles/JELKpDp.jpg)
- instead of add IgG, add anti-C3
![](https://photos.thisispiggy.com/file/wikiFiles/QzLF577.jpg)
- IgG cold association with syphilis
![](https://photos.thisispiggy.com/file/wikiFiles/CoNWy5b.jpg)
MAHA
![](https://photos.thisispiggy.com/file/wikiFiles/ZGtI3bz.jpg)
- intravascular hemolysis
- schistocytes: arrow, look like fragments
Mechanical
![](https://photos.thisispiggy.com/file/wikiFiles/rRuCD0O.jpg)
- very high BP causes endothelial damage
- thrombus shear RBC
![](https://photos.thisispiggy.com/file/wikiFiles/lHrJB9n.jpg)
- narrow openings, stiff tissues
Infections
![](https://photos.thisispiggy.com/file/wikiFiles/YiVCfo7.jpg)
- either intravascular RBC rupture or removal by spleen
![](https://photos.thisispiggy.com/file/wikiFiles/Wrjqqx2.jpg)
- sickle: Higher risk of severe disease in sickle cell disease
- hole in robin's shirt: Higher risk of severe disease in asplenia
- cracked blood stained windows: Hemolytic anemia
- yellow babe: Jaundice
- Sweating robin: fever
- torn robin shirt: Irregularly cycling fevers
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