Color Atlas of Hematology - Practical Microscopic and Clinical ...

142Erythrocyte and Thrombocyte AbnormalitiesTable 24Causes of the most common hemolytic anemiasSpecial morphologicalfeatures of erythrocytesCauses within the erythrocytes (corpuscular hemolyses)➤➤Hereditary Membrane abnormalities– Spherocytosis (see p. 144)– Elliptocytosis Hemoglobin abnormalities– Thalassemia (see p. 138)– Sickle cell anemia (seep. 144)– Other rare hemoglobinrelateddisorders Enzyme defects– Glucose-6-phosphatedehydrogenase– Pyruvate kinase andmany othersAcquired Paroxysmal nocturnalhemoglobinuria Zieve syndrome– Small spherocytes– Elliptocytes– Target cells– Sickle cells– Possibly Heinz bodies– Macrocytes– Foam cells in the bonemarrowFurther advanceddiagnosticsOsmotic resistanceHemoglobin electrophoresisEnzyme testsSucrose hemolysistest, absence of CD 55(DAF) and CD 59MIRL (membraneinhibitor of reactivelysis)Causes outside the erythrocytes (extracorpuscular hemolyses)➤ Biosynthesis of antibodies Isoantibodies (fetal erythroblastosis,Rh serologytransfusion events) Warm autoantibodiesCoombs test Cold autoantibodies – Autoagglutination Coombs test,Cold agglutinationtiter Chemical-allergic antibodies(e. g., cephalosporin, methyldopa)➤ Physical or chemical noxae(e. g., after burns, heart valvereplacement; heavy metalexposure, animal- or plantderivedpoisons)– Partially Heinz bodies➤ Microangiopathic hemolysis inhemolytic-uremic syndrome,thrombotic-thrombocytopenicpurpura, bone marrow carcinoses➤ Infection-related noxae (e. g.influenza, salmonella infection,malaria)➤Hypersplenism, e. g. lymphaticsystem disease, infections withsplenomegaly, portal hypertension– Schizocytes, fragmentocytes(see p. 143)– For malaria pathogen(see p. 158)Thrombocytes Liver, kidneyDemonstration ofpathogenCause ofsplenomegaly