Microangiopathic Hemolytic Anemia: Etiology

by Carlo Raj, MD

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    00:01 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.

    00:10 Welcome to Microangiopathic 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.

    00:20 Helmet cells.

    00:22 Let's continue.

    00:24 So what we have here is inside my blood vessel, and we'll begin by looking at microangiopathic.

    00:29 It's a mechanical damage.

    00:31 Meaning to say that this is not a problem within the RBC, so therefore you would then refer to this being an extrinsic problem.

    00:39 And by extrinsic, we mean that the issue is taking place outside the RBC.

    00:43 Where are you? In your blood vessel.

    00:46 There's a separate potential mechanism to which the red blood cell maybe damage by the blood vessel.

    00:51 First, if a patient has a mechanical heart valve, the turbulent blood through the mechanical valve itself, may induce damage to the red blood cells, or secondly malignant hypertension can create a pro-thrombotic environment.

    01:03 Resulting in small clots forming in the microvasculature.

    01:06 As the red blood cells trying to pass through this occluded vessels, their cells wall are deform and ultimately damaged.

    01:12 Continuing, so let's say that you're in a little blood vessel and in the little blood vessel, you are then forming a thrombus.

    01:20 Why? Well, that thrombus formation is not homeostatic in terms of it wasn't dissolved quickly and you have excess thrombi in your microvasculature.

    01:32 Well, same consequence.

    01:35 We talked about hypertension maybe or mechanical type of issues with heart valves.

    01:40 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.

    01:50 It will look like a schistocyte. You call this a helmet cell.

    01:53 The three conditions that often are associated with thrombotic disorders include DIC, TTP, and HUS.

    02:03 A couple things real quick, if it's DIC, it's devastating.

    02:07 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.

    02:19 There's bleeding that's taking place in every single orifice.

    02:22 Every single platelet has been consumed.

    02:25 Every single coagulation factor has been consumed.

    02:29 So therefore you're going to find an increase in PT, PTT, and bleeding time.

    02:33 Or you're going to find a decrease in platelet count.

    02:36 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.

    02:51 Clear? Now, the triggers for DIC are quite unique.

    02:56 Maybe, maybe it was a Acute Myelogenous Leukemia Type III.

    03:02 How many letters in DIC? One, two, three. M3.

    03:07 Maybe it was amniotic fluid emboli. Maybe it was sepsis. Sepsis is a big one.

    03:13 Maybe it was some type of venom, maybe perhaps some snake venom.

    03:18 So the origin or the true etiology of DIC, it's a little peculiar.

    03:23 But when it takes place and you have that trigger, oh, it's really dangerous.

    03:28 Really dangerous, close to death, if not, already.

    About the Lecture

    The lecture Microangiopathic Hemolytic Anemia: Etiology by Carlo Raj, MD is from the course Hemolytic Anemia – Red Blood Cell Pathology (RBC).

    Included Quiz Questions

    1. Schistocyte
    2. Dacryocyte
    3. Echinocyte
    4. Acanthocyte
    5. Spherocyte
    1. Disseminated intravascular coagulation, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura
    2. Diabetes mellitus, disseminated intravascular coagulation, hemolytic uremic syndrome
    3. Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura
    4. Diabetes mellitus, idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura
    1. Low platelets, increased PT, increased PTT, increased bleeding time
    2. Low platelets, increased PT, increased PTT, normal bleeding time
    3. Normal platelets, increased PT, increased PTT, increased bleeding time
    4. Normal platelets, increased PT, normal PTT, normal bleeding time
    5. Low platelets, normal PT, normal PTT, increased bleeding time

    Author of lecture Microangiopathic Hemolytic Anemia: Etiology

     Carlo Raj, MD

    Carlo Raj, MD

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