DR Medhat MRCP

Chronic Hemolytic Anemia with acute exacerbations
Long standing 1. Mild Jaundice C/P of anemia recurrent crisis
2. HSM A. Hemolytic crisis
3. Gall stones. - Fever with rigors
4. Reticulocytosis. - Loin pain
5. Indirect hyperbilirubinemia. - Bone aches.
6. Low (consumed) haptoglobin. - pallor &
7. High LDH. jaundice
8. BM erythroid hyperplasia B. Aplastic crisis.
( may interrupted by hypoplasia C. Sickle cell crisis
During infection`aplastic crisis`)
(only in sickle cell disease)
Vascular occlusive crisis
Sequestration crisis.
Transfusion Reactions
• Acute complications(i.e during transfusion to few hours after) :
1. Acute intravascular hemolysis (anti A & B IgM), ≥ 4 mm incompatible ABO is fatal.
2. Acute bacterial infection & shock ( rare in RBCs but common with platelet
transfusion `stored in room temp.`)
3. Transfusion related acute lung injury (TRALI) [donor plasma HLA against patient`s
neutrophils→cytokines→↑ alveolar capillary permeability→non cardiogenic
pulmonary oedema →acute respiratory distress within 6 hrs after transfusion.
4. Fluid overload & pulmonary edema.
5. Non-hemolytic febrile reaction to transfused platelets & RBCs (fever + rigors).
6. Anaphylaxis (type 1 hypersensitivity `IgE mediated`)
• Delayed complications (24 hours after transfusion due to development of RBCs
Alloantibodies → uexplained pyrexia ,jaundice & anemia ):
1. Delayed extravascular hemolysis of transfused RBCs
- IgG mediated , More common than acute intravascular hemolysis.
2. Development of Abs in patient plasma → allo-immunisation.
3. Post transfusion purpura.
4. Iron overload.
5. Chronic infection (Hepatitis , HIV).
6. Immunmodulation.
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