HEMOLYTIC ANEMIA Presented by: Ally Dhalla Sandeep Gothi Ujjwal Patel Presented JAN PHM 226, Example Instructor: Dr. Jeffrey Henderson
What is hemolytic anemia? Hemolytic anemia is a disorder in which the red blood cells are destroyed prematurely. RBCs are destroyed faster than the bone marrow can produce them. There are two types of hemolytic anemia: Extrinsic and Intrinsic
Types of Hemolytic Anemia Extrinsic - red blood cells are produced healthy but are later destroyed by becoming trapped in the spleen, destroyed by infection, or destroyed from drugs that can affect red blood cells. Intrinsic - the destruction of the red blood cells due to a defect within the red blood cells themselves. Intrinsic hemolytic anemia is often inherited, such as sickle cell anemia and Glucose- 6-Phosphate Dehydrogenase deficiency. (G6PD)
What is G6PD? It is an X-linked recessive inheritance. (males usually affected and females are carriers) Risk factors: being black, being male, or having a family history of G6PD deficiency. G6PD enzyme functions in the Pentose-Monophosphate shunt and in the process, catalyzes the reduction of NADP+ to NADPH required in triggering a cascade of events that can detoxify the harmful oxidant H 2 O 2.
Role of G6PD Responsible for maintaining adequate levels of NADPH inside cell. The oxidation of NADPH back to NADP+ is coupled with the reduction of oxidized glutathione (GSSG) to glutathione (GSH). Thus, NADPH keeps glutathione, a tri-peptide, in its reduced form.
Role of G6PD Cont’d... Reduced glutathione (GSH) acts as a scavenger for dangerous oxidative metabolites in the cell. GSH converts harmful hydrogen peroxide to water catalyzed by the enzyme, glutathione peroxidase (catalase enzyme also detoxifies H 2 O 2 ). If H 2 O 2 cannot be detoxified by GSH or catalase, hydroxyl radical formed from H 2 O 2 can be scavenged by Vit C/E.
G6PD Deficiency Red cells deficient in G6PD are unable to neutralize hydrogen peroxide - H 2 O 2 converts to hydroxyl radicals and this can lead to oxidative damage/toxic injury. Impaired response to oxidizing drugs can also induce hemolytic anemia (Individuals with G6PD deficiency are particularly susceptible)
Glycolytic Pathway Glucose Glucose-6-phosphate ATP ADP Fructose-6-phosphate hexokinase isomerase Fructose-1,6-bisphosphate ATP ADP Glyceraldehyde- 3-phosphate Dihydroxy- acetone Phosphate PFKinase G-3-P Dehydrogenase NAD+NADH 1,3-Bisphosphoglycerate Pyruvate NAD+ Fe 3+ + O 2 O 2 + Fe 2+ MetHb reductase (2 Net ATP) Drugs H2O2H2O2 Know this diagram
Drugs that affect it Drugs that can precipitate this reaction include: anti-malarial agents sulfonamides (antibiotic) aspirin non-steroidal anti-inflammatory drugs (NSAIDs) nitrofurantoin quinidine quinine others Also: exposure to certain chemicals such as those in mothballs and flava beans.
What are the symptoms? The most common symptoms include: –abnormal paleness or lack of color of the skin –jaundice, or yellowing of the skin, eyes, and mouth –dark color to urine –fever –weakness –dizziness –confusion –intolerance to physical activity
Signs of anemia include: pale skin and fingernails rapid pulse heart murmur Enlarged spleen and liver
Required Tests Blood tests are taken to measure levels of: –red cells, assess size and shape of red cells –measure the Hb level –determine the number of reticulocytes. Other blood tests may include: Coombs' test (direct and indirect) — checks for hemolytic anemia caused by an abnormal immune reaction. Heinz body presentation — looks for a deficiency in amount of G6PD enzyme, which results in hemolysis if certain medications or foods are ingested.
Treatments may include Stopping use of offending drug. For more severe cases, treat with: corticosteroids (e.g. prednisone) intravenous immunoglobulin infusions immunosuppressive (e.g. azathioprine (Imuran) and cyclophosphamide (Cytoxan) Vitamin and mineral supplements (e.g. folic acid). Change in diet. If Hb levels ↓, treatment may include blood transfusion or splenectomy (surgical removal of the spleen). If physical damage to RBC, then treat w/ blood transfusions or simple iron supplements. Iron - Taken during pregnancy and when iron levels are low. Erythropoietin (Procrit) - To increase RBC production in people w/ kidney problems.