Learning Objectives
- Classify haemolytic anaemia.
- Understand the pathology underlying intravascular and extravascular haemolysis.
- Investigation of suspected haemolysis.
- Understand the principles underlying a Direct Coombs test.
- Emergency management of acute haemolytic anaemias.
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Question 1 of 10
1. Question
1 point(s)A 70-year-old female presents to the Emergency Department with a three-week history of worsening fatigue and dyspnoea on exertion. On examination, there is conjunctival pallor, scleral icterus and splenomegaly 5 finger breadths below the costal margin. Initial investigations show:
Haemoglobin 5.7g/dL (11.4-14.7)
MCV 101fL (83.0-95.5)
Platelets 223×109/L (164-387)
WBC 24.4×109/L (3.84-10.01)
Neutrophils 4.0×109/L (1.56-6.27)
Lymphocytes 18.4×109/L (0.91-3.52)Iron 9.5µmol/L (9.5-30.0)
Ferritin 350 µg/L (20-300)
Transferrin 190 mg/dL (200-360)
TIBC 57% µmol/L (52-94)
Iron saturation 17% (20-50)B12 232pmol/L (135-675)
Folate 7nmol/L (7-45)What test you order next?
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Question 2 of 10
2. Question
1 point(s)The peripheral blood film is reported as showing spherocytes with polychromasia. Other investigations are shown below:
Reticulocyte count: 7% (0.84-2.21%)
Reticulocyte count (absolute): 328.50×109/L (38.30-110.50)Albumin 38g/L (38-48)
Bilirubin, total 125µmol/L (5-30)
Bilirubin, conjugated 5µmol/L (0-5)
Bilirubin, unconjugated 120µmol/L (5-25)
AST 35U/L (10-50)
ALT 62U/L (10-70)
ALP 120U/L (40-130)LDH 1760U/L (250-580)
Haptoglobin <30mg/dL (30-200)What is the most likely diagnosis?
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Question 3 of 10
3. Question
1 point(s)Which of the following about serum haptoglobin is true?
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Question 4 of 10
4. Question
1 point(s)Which of the following about lactate dehydrogenase is true?
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Question 5 of 10
5. Question
1 point(s)You suspect she has a haemolytic anaemia.
What test would you send next?
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Question 6 of 10
6. Question
3 point(s)A poly-specific Direct Coombs test will be positive in which of the following conditions? Check all that apply.
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Question 7 of 10
7. Question
1 point(s)The DCT comes back strongly positive for IgG. There is no history of blood transfusion or drug exposure. You suspect that she has autoimmune haemolytic anaemia (AIHA). Spherocytes are seen on her peripheral blood film.
What are spherocytes?
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Question 8 of 10
8. Question
1 point(s)Her peripheral blood film is shown below:
What is the most likely underlying diagnosis?
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Question 9 of 10
9. Question
1 point(s)A diagnosis of CLL is confirmed via immunophenotyping of the peripheral blood. She has been afebrile, with no night sweats or weight loss. On examination, small volume cervical, axillary and inguinal lymph nodes are palpable.
How would you manage her AIHA?
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Question 10 of 10
10. Question
1 point(s)Given her symptomatic anaemia, she is transfused with 1 unit of packed red cells and started on prednisolone 1mg/kg.
Which vitamin / mineral should be supplemented in patients with active haemolysis?
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