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MLS 3310 - EXAM 3 AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA) QUESTIONS WITH ALL PASSED ANSWERS!!!.
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MLS 3310 - EXAM 3 AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA) QUESTIONS WITH ALL PASSED ANSWERS!!!.
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MLS 3310 - EXAM 3 AUTOIMMUNEHEMOLYTIC ANEMIA (AIHA)
QUESTIONS WITH ALL PASSED
ANSWERS!!!
Auto-immune Hemolytic Anemia - Answer 1) *Hemolytic Anemia*: Anemia due to
immune process - drop in hemoglobin and hematocrit due to shortened red cell survival.
2) *Autoimmune*: antibody directed against self antigens on the patient's red blood cells
3) *Autoantibody Specificity*: most react with high incidence antigens such as *anti-e or
anti-I* - these agglutinate virtually every cell on an antibody screen and almost all
reagent panel cells.
Autoimmune Hemolytic Anemia - Answer 1) Combining patient serum with most donor,
reagent, and self red blood cells will cause: Agglutination *or* Coating with antibody
and/or Complement *or* Cell lysis (or a combination of all three!!) - autoantibody with
broad specificity, an antibody that virtually reacts with all cells, either by direct
agglutination, sensitization, C' activation to completion. or a combination of all 3. Is
autoantibody masking a clinically significant alloantibody?
Categories:
• Warm autoimmune hemolytic anemia (70%)
• Cold autoimmune hemolytic anemia (18%)
• Drug induced hemolytic anemia (12%)
Auto-immune Hemolytic Anemia -
Rule out Other Causes Of Hemolysis such as - Answer 1) Hereditary spherocytosis 2)
Hemoglobinopathy 3) Sickle cell crisis 4) Infusion of hemolyzed RBCs 5) Infusion of
toxic substances
Auto-immune Hemolytic Anemia -
Rule out Other Causes Of Hemolysis GOAL - Answer To distinguish other sources of
hemolysis from the ones that apply to the blood bank. This takes some investigation --
good patient history, testing, etc. Patient's current status needs to be assessed.
ASSESSMENT of Patient Status - Answer • *Patient History*: Transfusion and
pregnancy history (can give hints of alloantibodies in addition to autoantibodies), Patient
Medication History (some medications have been implicated in the autoimmune
process)
• *Laboratory Tests*: 1) Direct Antiglobulin Test - IgG and C' - find what is coating the
RBC. 2) Antibody Identification - on patient plasma and eluate. 3) Tests to search for
, additional clinically significant, unexpected antibodies - autoadsorption or enzyme
treatment of RBCs - these with patient history should effectively rule-in/out the
previously mentioned pathological processes - none of which have a positive DAT
(Hereditary spherocytosis, Hemoglobinopathy, Sickle cell crisis, Infusion of hemolyzed
RBCs, or infusion of Toxic substances) can be ruled out as the cause o the hemolysis -
because none of these will produce a positive DAT.
Cold Autoimmune Hemolytic Anemia - Answer 1) Table compares Benign to
Pathological cold auto antibodies.
2) Benign cold auto-antibodies -- have lower titer, usually <1:64, react at 4C, enhanced
by enzyme treated RBCs, good C' activators.
- Now not as significant because poly-specific AHG isn't only used. Anti-I = good
complement activator and cold antibody (non clinically significant)
Cold Hemagglutinin Disease - Pathological Cold Auto Antibodies - Answer • Tend to
have a high titer - 4C, >1:1000
• Broad thermal range of reactivity - pathological...agglutinates RBCs at a wider
temperature range, even up to 37C not just the optimal 4C
• Specificity: anti-I (almost always)
• Enhanced with enzyme treated red cells.
• Complement activators (IgM)
Cold Hemagglutinin Disease -
Classification - Answer 1) Chronic, 2) Idiopathic: No known cause, 3) Acute/transient
secondary to infectious disease or condition - Mycoplasma pneumoniae or Infectious
Mono, 4) Paroxysmal Cold Hemoglobinuria Box 21-1, page 448 Harmening
Cold Hemagglutinin Disease - Pathologic Cold Auto Antibody - Chronic: - Answer •
Often seen in elderly patients - tends to e associated with lymphoma, chronic
lymphocytic leukemia (CLL), or Waldenstrom's Macroglobulinemia.
• Increased Erythrocyte Sedimentation Rate (ESR) & Raynaud's phenomenon (when
patients displace symptoms of cold-intolerance) and hemoglobinuria seen during cold
weather - pain, blue-ish tint in fingertips and toes, as a result of vasospasms.
Cold Hemagglutinin Disease - Pathologic Cold Auto Antibody - Acute/Transient: -
Answer 1) Often secondary to: Mycoplasma pneumoniae infection or lymphoma,
specificity is an *anti-I*
2) Also can be seen in patient with: Infectious mononucleosis - specificity is an *anti-i*
3) Transient - autoantibody subsides when complete
Cold Hemagglutinin Disease -
Pathologic Cold Auto Antibody -
Paroxysmal Cold Hemoglobinuria: - Answer 1) Auto-Antibody with *anti-P* specificity -
aka *biphasic hemolysin* - it binds C' to the RBC membrane at cold temperatures and
then activates it to completion at warm temperatures = RBC destruction in-vivo (IgG
antibody)
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