What if you’re inside your
blood vessel and you’re an RBC
and you end up hitting an obstructive
and your head was chopped off?
That’s not very nice.
Welcome to micro- and
macroangiopathic hemolytic anemia,
and what we’re going to do with our
head being chopped off with an RBC,
referring to a schistocyte,
hence you should wear helmets.
So what we have here is
inside my blood vessel,
and we’ll begin by looking at
micro and macroangiopathic.
It’s a mechanical damage.
Meaning to say that this is
not a problem within the RBC,
so therefore you would then refer
to this being an extrinsic problem.
And by extrinsic, we mean that the
issue is taking place outside the RBC.
Where are you?
In your blood vessel.
So what is the difference between
micro- and macroangiopathic?
All it is quite simple.
If it’s macroangiopathic, then it is your
common, common diseases in our society
secondary to hypertension or
diabetes mellitus, in which, well,
the larger blood vessels are undergoing
obstruction or hyaline arteriolosclerosis,
and there’s every possibility that an RBC
might then get hurt and form a schistocyte.
Or you can have little blood vessels
that are undergoing thrombotic
diseases where our focus shall be.
So our focus, ladies and
gentlemen, in this lecture series,
will be in the format
However, keep in mind, if it’s
macroangiopathic type of hemolytic anemia,
it only means that your patient
has a systemic type of disease,
or diabetes mellitus,
resulting in the same type of
consequence where the RBCs
are extrinsically becoming hurt.
And the next question that you want to
ask yourself is, well, would this be
primarily a intravascular or
extravascular type of disorder?
It will primarily be an
which means your patient is going
to show up with hemoglobinuria.
Now, you can have mechanical or stenotic
heart valves known as Waring Blender effect,
in which for example, if you
have an RBC passing across,
let's say, a stenotic
or the patient was experiencing
something like an Austin Flint murmur,
which is a very, very severe
form of aortic regurgitation.
And you needed to replace that
valve , and when you do so,
you replaced it with a
in which now it causes increased
resistance or destruction to your RBC.
Are we clear?
Forming some type of micro and
macroangiopathic hemolytic anemia.
Ultimately, this RBC in which it has
been sheared will form a schistocyte,
you may also call
this a helmet cell.
The other one that we just referred to here
is in terms of your malignant hypertension
in which there’s enough pressure within
your blood vessel here once again
causing damage in RBC,
resulting in a type of anemia.
Keep this in mind because you have
systemic diseases in which ultimately
you’ll have blood vessels that are
then compromised and when they are,
it’s only the RBCs that
are going to become hurt.
So therefore, this angiopathic hemolytic
anemia is actually a pretty big deal
because you would see
it in many conditions.
so let’s say that you’re in a little blood
vessel and in the little blood vessel,
you are then forming a thrombus.
Well, that thrombus formation
is not homeostatic in terms of
it wasn’t dissolved quickly and you have
excess thrombi in your microvasculature.
Well, same consequence.
We talked about hypertension maybe or
mechanical type of issues with heart valves.
But then if you have a little thrombi
in which it offers
resistance to an RBC
to the point it’s actually causing
extrinsic damage to the RBC,
here once again, the RBC will get sheared.
It will look like a schistocyte.
You call this a helmet cell.
The three conditions that often are
associated with thrombotic disorders
A couple things real quick, if
it’s DIC, it’s devastating.
If this patient, when you see this
patient, with DIC rolling into your room,
then this is not good because
this is as close to death
as you shall see
with the patient.
There’s bleeding that’s taking
place in every single orifice.
Every single platelet has been consumed.
Every single coagulation
factor has been consumed.
So therefore you’re going to find an
increase in PT, PTT, and bleeding time.
You’ll find a decrease in platelet count.
And so therefore, you have all
this thrombi up and down the body,
guaranteed, your patient with DIC is
going to have what kind of anemia?
It will be a normocytic hemolytic type
of microangiopathic hemolytic anemia.
Now, the triggers for DIC are quite unique.
Maybe, maybe it was a acute
myelogenous leukemia type III.
How many letters in DIC?
One, two, three.
Maybe it was amniotic fluid emboli.
Maybe it was sepsis.
Sepsis is a big one.
Maybe it was some type of venom,
maybe perhaps some snake venom.
So the origin or the true etiology
of DIC, it’s a little peculiar.
But when it takes place and you have
that trigger, oh, it’s really dangerous.
Really dangerous, close to
death, if not, already.