Extrinsic hemolytic normocytic anemia: Pathology review
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Extrinsic hemolytic normocytic anemia: Pathology review
Hematological system
Anemias
Iron deficiency anemia
Beta-thalassemia
Alpha-thalassemia
Sideroblastic anemia
Anemia of chronic disease
Lead poisoning
Hemolytic disease of the newborn
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Autoimmune hemolytic anemia
Pyruvate kinase deficiency
Paroxysmal nocturnal hemoglobinuria
Sickle cell disease (NORD)
Hereditary spherocytosis
Anemia of chronic disease
Aplastic anemia
Fanconi anemia
Megaloblastic anemia
Folate (Vitamin B9) deficiency
Vitamin B12 deficiency
Fanconi anemia
Diamond-Blackfan anemia
Heme synthesis disorders
Acute intermittent porphyria
Porphyria cutanea tarda
Lead poisoning
Coagulation disorders
Hemophilia
Vitamin K deficiency
Platelet disorders
Bernard-Soulier syndrome
Glanzmann's thrombasthenia
Hemolytic-uremic syndrome
Immune thrombocytopenic purpura
Thrombotic thrombocytopenic purpura
Mixed platelet and coagulation disorders
Von Willebrand disease
Disseminated intravascular coagulation
Heparin-induced thrombocytopenia
Thrombosis syndromes (hypercoagulability)
Antithrombin III deficiency
Factor V Leiden
Protein C deficiency
Protein S deficiency
Antiphospholipid syndrome
Lymphomas
Hodgkin lymphoma
Non-Hodgkin lymphoma
Leukemias
Chronic leukemia
Acute leukemia
Leukemoid reaction
Leukemoid reaction
Dysplastic and proliferative disorders
Myelodysplastic syndromes
Polycythemia vera (NORD)
Myelofibrosis (NORD)
Essential thrombocythemia (NORD)
Langerhans cell histiocytosis
Mastocytosis (NORD)
Plasma cell dyscrasias
Multiple myeloma
Monoclonal gammopathy of undetermined significance
Waldenstrom macroglobulinemia
Hematological system pathology review
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Heme synthesis disorders: Pathology review
Coagulation disorders: Pathology review
Platelet disorders: Pathology review
Mixed platelet and coagulation disorders: Pathology review
Thrombosis syndromes (hypercoagulability): Pathology review
Lymphomas: Pathology review
Leukemias: Pathology review
Plasma cell disorders: Pathology review
Myeloproliferative disorders: Pathology review
Assessments
Extrinsic hemolytic normocytic anemia: Pathology review
USMLE® Step 1 questions
0 / 8 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Hematologic | |
| Hemoglobin | 8.1 g/dL |
| Mean corpuscular volume (MCV) | 86 fL |
| Platelet count | 80,000/mm3 |
| Reticulocyte count | 4.6% |
| Haptoglobin | 100 mg/dL (N = 50-220) |
| Blood, plasma, serum | |
| Lactate dehydrogenase (LDH) | 1080 U/L |
Memory Anchors and Partner Content
Transcript
Content Reviewers
Yifan Xiao, MDContributors
Jung Hee Lee, MScBMC
Maria Emfietzoglou, MD
Kaylee Neff
Tanner Marshall, MS
At the family medicine center, two people came in with progressive fatigue.
One of them is a 60 years old named Will whose past medical history included an aortic valve replacement with a mechanical valve due to severe aortic stenosis.
There’s Hanna, a 28 years old female of African descent.
She was diagnosed a year ago with systemic lupus erythematosus, or SLE. CBC is ordered for both people and it shows low hemoglobin with normal mean corpuscular volume, or MCV and reticulocyte count index over 2%.
They also have increased LDH. Now, Will has schistocytes on peripheral blood smear, while Hanna has spherocytes.
Both Will and Hannah are suffering from anemia, which is defined as lower than average levels of hemoglobin, typically below 13.5 g/dL in adult men and below 12.0 g/dL in adult women.
For children, this level varies based on the age. Now, anemias can be broadly grouped into 3 categories based on =MCV, which reflects the volume of an RBC.
So microcytic anemia is where the MCV is lower than 80 fL, normocytic, with an MCV between 80 and 100 fL, and macrocytic, with an MCV larger than 100 fL.
Normocytic anemias can be further classified as hemolytic when there’s increased destruction of RBCs, or hemolysis, and non-hemolytic when there’s decreased production of RBCs from the bone marrow.
When there’s hemolysis, the bone marrow revs up and starts pumping out immature RBCs called reticulocytes, but when there’s a bone marrow problem reticulocyte count is low.
So for your exams, it’s important to know that in hemolytic anemias there’s an increased reticulocyte production index of over 2%, while in non-hemolytic anemias it’s lower than 2%.
Alright, now hemolytic anemias can be classified as intrinsic or extrinsic hemolytic anemias.
In intrinsic hemolytic anemias, RBCs are destroyed because they’re defective, while in extrinsic hemolytic anemias, RBCs are normal but are later destroyed outside the bone marrow.
In this video, let’s focus on extrinsic hemolytic anemias that include autoimmune hemolytic anemia, microangiopathic hemolytic anemia, macroangiopathic hemolytic anemia and infections.
Sources
- "Kaplan USMLE Step 2 CK Lecture Notes Internal Medicine" Kaplan Medical (2017)
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Hemolytic Anemia: Evaluation and Differential Diagnosis" Am Fam Physician (2018)
- "Autoimmune hemolytic anemia" Hematology (2018)
- "Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review" Wiener klinische Wochenschrift (2008)
- "Hemolytic uremic syndrome" Türk Pediatri Arşivi (2015)
- "Haemolytic uremic syndrome: diagnosis and management" F1000Research (2019)
- "Management of thrombotic thrombocytopenic purpura: current perspectives" Journal of Blood Medicine (2014)
- "Thrombotic microangiopathies: a general approach to diagnosis and management" Canadian Medical Association Journal (2016)
- "Relationships between anaemia and parasitic infections in Kenyan schoolchildren: A Bayesian hierarchical modelling approach" International Journal for Parasitology (2008)
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