Immunohemolytic Anemia o Antibodies bind to red cells, leading to their premature destruction.

o Diagnosis requires the detection of antibodies and/or complement on red cells from the patient o direct Coombs antiglobulin test patient's red cells are mixed with sera containing antibodies that are specific for human immunoglobulin or complement. (MCQ) If either immunoglobulin or complement is present on the surface of the red cells, the multivalent antibodies cause agglutination, which is easily appreciated visually as clumping. o indirect Coombs antiglobulin test patient's serum is tested for its ability to agglutinate commercially available red cells bearing particular defined antigens This test is used to characterize the antigen target temperature dependence of the responsible antibody Warm Antibody Type. This is the most common form of immunohemolytic anemia(MCQ) About 50% of cases are idiopathic (primary); (MCQ) Most causative antibodies are of the IgG class; less commonly, IgA (MCQ) The red cell hemolysis is mostly extravascular(MCQ) IgG-coated red cells bind to Fc receptors on phagocytes, which remove red cell membrane during partial phagocytosis. the loss of membrane converts the red cells to spherocytes, which are sequestered and removed in the spleen. Moderate splenomegaly due to hyperplasia of splenic phagocytes is usually seen. (MCQ) Antigenic drugs. hemolysis usually follows large, intravenous doses of the offending drug occurs 1 to 2 weeks after therapy is initiated Seen in penicillin and cephalosporins, quinidine(MCQ) Tolerance-breaking drugs(MCQ) -methyldopa is the prototype produce of antibodies against red cell antigens, particularly the Rh blood group antigens. Cold Agglutinin Type immunohemolytic anemia caused by IgM antibodies (MCQ) bind red cells avidly at low temperatures (04C) (MCQ) they appear transiently following certain infections, such as with (MCQ)

Mycoplasma pneumonia Epstein-Barr virus cytomegalovirus, influenza virus human immunodeficiency virus (HIV). In these settings the disorder is self-limited antibodies rarely induce clinically important hemolysis. Chronic cold agglutinin immunohemolytic anemia occurs in association with certain B-cell neoplasms or as an idiopathic condition. (MCQ) more difficult to treat unlike antibody immunohemolytic anemia Vascular obstruction caused by agglutinated red cells results in pallor, cyanosis, and Raynaud phenomenon in body parts exposed to cold temperature. (MCQ) Cold Hemolysin Type. Cold hemolysins autoantibodies responsible for an unusual entity known as paroxysmal cold hemoglobinuria. causes substantial, sometimes fatal, intravascular hemolysis and hemoglobinuria. (MCQ) The autoantibodies are IgGs (MCQ) IgGs bind to the P blood group antigen on the red cell surface in cool, peripheral regions of the body. (MCQ) Complement-mediated lysis occurs when the cells recirculate to warm central regions, since the complement cascade functions more efficiently at 37C. (MCQ) Most cases are seen in children following viral infections; in this setting the disorder is transient, and most of those affected recover within 1 month. Hemolytic Anemia Resulting from Trauma to Red Cells seen in individuals with cardiac valve prostheses Artificial mechanical cardiac valves are more frequently implicated than are bioprosthetic porcine valves(MCQ) Microangiopathic hemolytic anemia Causes (MCQ) most commonly seen with disseminated intravascular coagulation thrombotic thrombocytopenic purpura (TTP) hemolytic-uremic syndrome (HUS) malignant hypertension systemic lupus erythematosus, disseminated cancer. The common pathogenic feature in these disorders is a microvascular lesion that results in luminal narrowing, often due to the deposition of fibrin and platelets. These vascular changes produce shear stresses that mechanically injure passing red cells

. Regardless of the cause, traumatic damage leads to the appearance of (MCQ) red cell fragments (schistocytes), burr cells, helmet cells, triangle cells in blood smears