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What are the performance of hemolytic anemia and how to diagnose?
First, clinical manifestations
The clinical manifestations of hemolytic anemia, hemolytic process depends on the priority and the main site of hemolysis (intravascular or extravascular), often rapid onset of acute hemolysis, such as blood type found in sub-transmission, short-term hemolysis could be significantly large number of chills, followed by high fever, low back and limb pain, with headache, vomiting, the patient was pale and jaundice, which is due to extensive damage to red blood cells, and its decomposition products due to the toxic effects on the body, may have more serious peripheral circulatory failure, due to hemolysate renal tubular cell necrosis and luminal obstruction, eventually leading to acute renal failure, the slow onset of chronic hemolysis, mild symptoms of anemia, jaundice, hepatosplenomegaly three characteristics, chronic hemolytic anemia due to the long hyperbilirubinemia may be complicated by cholelithiasis and liver damage, such as performance,
During acute hemolysis in acute bone marrow function can still be a sudden failure, manifested as extreme reduction of reticulocytes, a sharp increase in anemia, aplastic crisis, said, the principle may occur infection, poisoning, may also act on the maturity of the antibody also red blood cells and immature red blood cells caused by
Second, the diagnosis
Excessive destruction of red blood cells of both compensatory and


erythroblastic hyperplasia, or hemoglobinuria and other intravascular hemolysis who can consider the diagnosis of hemolytic anemia, hemolytic anemia, but must pay attention to any liver damage in patients who also may be associated with Fat jaundice and some cases of liver cells and blood vessels outside the intravascular hemolysis is sometimes difficult to distinguish sharply, in some cases, vascular and extravascular hemolysis often in combination, in varying degrees, due to viral infection or some other unknown cause, may be associated with acute hemolytic severe bone marrow failure, excessive destruction of red blood cells at this time only in patients without compensatory proliferation of the phenomenon, these points must be taken into account when analyzing the case,
In the etiology, if chemistry, history of exposure to physical factors, generally easy to positive, such as anti-human globulin test positive, they should first consider the autoimmune hemolytic anemia, abnormal blood film obvious exception of red blood cell membrane should first genetic defects hemolytic anemia, blood film had more target-shaped, should be hemoglobin electrophoresis, to exclude hemoglobin disease, red blood cell deformity is not obvious, except to be caused by defects in hereditary hemolytic activity, in short, the diagnosis of hemolytic disease not only according to the steps conducted, but also grabbed the experimental nature of choice, one by one rule out or confirm it,
First, the symptoms of hemolytic anemia
According to the site of destruction of red blood cells were divided into intravascular hemolysis and extravascular hemolysis of two types. Acute intravascular hemolysis hemolysis was generally, but also can be expressed as chronic hemolytic process, common in paroxysmal nocturnal hemoglobinuria, G-6PD deficiency, cold antibody type autoimmune hemolytic anemia, and drugs, chemical, infection and other factors cause of hemolytic anemia. Chronic extravascular hemolysis hemolytic process was generally more common in hereditary spherocytosis, hemoglobinopathies, warm antibody type autoimmune hemolytic anemia.
The clinical manifestations of hemolytic anemia and hemolytic priority, extent and location related.
1, acute hemolytic
Rapid onset may be sudden chills, fever, pale, back pain, shortness of breath, fatigue, irritability, can also be nausea, vomiting, abdominal pain and other gastrointestinal symptoms. This is due to extensive damage to red blood cells, and its decomposition products due to the toxic effects on the body. Concentration of free hemoglobin in the plasma over 130mg%, ie from the urine, there hemoglobinuria, urine color, such as tea or soy sauce-like concentration after 12 hours, there may be jaundice, hemolysate tubular cell damage, causing necrosis and deposition of hemoglobin tubules, and weak peripheral circulation and other factors, can cause acute renal failure. As anemia, hypoxia, severe apathy consciousness or coma may occur, shock and cardiac insufficiency.
2, chronic hemolytic
Slow onset. In addition to fatigue, pale, shortness of breath, dizziness, general anemia and other common symptoms, signs, may have varying degrees of jaundice, spleen, hepatomegaly more common, as were more common complication of gallstones, obstructive jaundice can occur . Lower limb ankle skin ulcers, difficult to heal, is common in patients with sickle cell anemia.
Second, treatment of hemolytic anemia
Hemolytic anemia caused by a variety of different treatment methods are not the same. The treatment of hemolytic anemia, in principle, have to remove the cause and symptomatic treatment.
1, remove the cause
Part of a clear cause of hemolytic anemia, if it is caused by external factors, generally can be removed. As a result of consumption of beans, or exposure to drugs, toxins caused by hemolysis, should stop with such items. Such as pollution caused by blood group incompatibility or transfusion reactions, transfusion should be stopped immediately. Removal of the most fundamental cause is the most effective treatment. The cause of preventable, prevention is more important than treatment. If it is caused by the red blood cell intrinsic defects, mostly congenital, the current level of medical treatment to correct or remove the cause is very difficult. Then generally only for symptomatic treatment.First indication to strictly control blood transfusions, and secondly to choose the appropriate blood components. Such as severe acute hemolytic anemia and hypoxia when life-threatening, blood transfusion is an important means of saving lives. In order to reduce transfusion reaction, reduce the burden on the heart, the best input concentration of red blood cells or frozen red blood cells, so that you can enter more red blood cells.
Blood transfusion, should pay particular attention the following special circumstances of hemolytic anemia. a. Autoimmune hemolytic anemia: red blood cell transfusion, there may be damage to the input, but increased hemolysis and jaundice. Last resort, need a blood transfusion should be selected with the smallest aggregation of blood when the blood, and blood transfusion rate must be slow, and keep close observation, one a response, immediate shutdown. b. Paroxysmal nocturnal hemoglobinuria: blood transfusion and hemolytic crisis may occur thrombosis, if the critical condition, requiring blood transfusion, should be used repeatedly washed red blood cells or frozen red blood cells. c.Rh factor alloimmune hemolytic disease of newborns caused by: need for exchange transfusion blood transfusion, so that one can correct anemia, on the other hand is more important, it can change the plasma concentrations of Rh antibody and high bilirubin, prevent the continued hemolysis and kernicterus.
The treatment of anuria and renal failure
Incompatible blood transfusion can cause acute hemolysis, hemoglobinuria severe, is likely to lead to anuria and renal failure. Studies suggest that mainly lead to renal failure caused by blood group incompatibility occurs when the immune hemolytic reaction of shock, blood pressure decline in the renal blood vessels, insufficient blood supply, resulting in kidney tissue necrosis. With a solution is to take rehydration, boost and other measures to maintain a certain level of blood pressure, prevent shock. If there is no urine, should be taken, including dialysis and other treatment measures for acute renal failure.
other treatment
Note electrolyte balance: Acute massive haemolysis, intravascular hemolysis in particular, the large number of red blood cell potassium ions are released into the plasma, so pay attention to electrolyte balance in patients.
Folic acid supplementation: chronic hemolysis, due to the long-term bone marrow erythroid cells proliferated, consumption of a large number of folic acid can occur within the class of bone marrow megaloblastic cells. Therefore, patients with chronic hemolysis, folic acid should be added.
Corticosteroids: to alleviate autoimmune hemolytic anemia has a good effect.
Splenectomy: the spherical cell histiocytosis hereditary anemia is very effective to eliminate, but does not change the red blood cells splenectomy inherent defects. Splenectomy on the part of the autoimmune hemolytic anemia are also effective.
Light therapy: can patients with hemolytic high plasma bilirubin children shift, so more quickly excreted.


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