Here, we’ll take a look
at normocytic anemia
and under normocytic, this
time, it’s hemolytic anemia.
What does that mean to you?
It means that the bone
marrow is now compensating,
the bone marrow is trying to now compensate
for the increased destruction of that RBC.
So therefore, you call this
Clinically, we refer to this being
reticulocyte production index.
The magic number then you’ll have
to memorize is greater than 3%.
Now, that would be in two
And the reason that we have two
categories with hemolytic anemia
is because your RBC can be destroyed –
Well, there’s a problem
within the cell itself.
So we will first go through
but ladies and gentlemen, this
is not going to picture –
Or the picture that you’re going to
get here is not the clinical picture,
it’s just the pathogenesis
of the disease.
So what you’re paying attention to
as you go through each one of these
intrinsic and extrinsic
well, is the destruction of RBC
taking place within the blood vessel,
hence intravascular, or is it
destruction of the RBC, hemolysis,
taking place outside of the blood
vessel primarily at the spleen
and that would be
extravascular, is that clear?
So the way that this is divide
into intrinsic and extrinsic
doesn’t mean that it’s only
intravascular or extravascular.
I will sound like a broken
record over and over
again until this point
gets hammered home,
so without further ado, let’s
get into our issues here.
We’ll walk through
These membrane defects include hereditary
spherocytosis, elliptocytosis, and PNH.
Next, under intrinsic, remember this
would mean that the RBC itself,
there’s a pathology inside the
cell itself intrinsically.
But what I wish to point out to you is,
for example, under membrane defect –
Well, membrane defect is
an intrinsic problem,
but hereditary spherocytosis will
be an extravascular hemolysis.
What does that mean to you?
Well, when we do talk about
HS, hereditary spherocytosis,
we’ll talk about this patient being
very, very jaundiced significantly.
And maybe perhaps a development of
pigment stones or cholelithiasis,
whereas something like paroxysmal
nocturnal hemoglobinuria, PNH,
will be an intravascular
type of hemolysis.
Under abnormal hemoglobin,
we’ll walk through sickle cell and HbC
disease and deficiency of enzymes.
You may use the mnemonic MAD.
A- Abnormal hemoglobin.
D- Deficiency of enzymes.
At least it will give you an idea as to
what’s going on with hemolytic anemias.
Under deficiency of enzymes,
we will walk through G6PD deficiency
and pyruvate kinase deficiency.
The other thing that I wish to point out
to you is under abnormal hemoglobin,
notice that we do not have
thalassemias here, clear?
Thalassemia, you know is a
problem with hemoglobin,
but what category does that come under?
Do you remember that?
Okay, dealing with your globin,
but that’s why we don’t find
thalassemias under normocytic.
On the side of extrinsic
defect, what does that mean?
Your RBCs are passing through and it gets
hit by a valve that was stenotic and rigid.
That will be extrinsic defect.
Now if it is blood loss greater
than 1 week, what does that mean?
Well, greater than 1 week, this would start
meaning that you have reticulocytosis,
isn’t that what you’re
paying attention to?
So greater than 1 week, now the
bone marrow is in fact working
because the erythropoietin
has kicked in
and so therefore now you
have production of your RBCs,
we call this increased
Immune hemolytic anemias
we’ll walk through.
Autoimmune hemolytic anemia,
and the differences between
micro and macroangiopathic.
And we’ll take a look
at malaria quickly.
So here’s a broad category and algorithm,
which is showing you all the
major hemolytic anemias.