天津医科大学内科学课件 Anemia in adults.pptVIP

Folate For some patients with chronic hemolytic disorders, folic acid is useful in preventing megablastic crisis. Folic acid is particularly valuable for patients with severe, continuing hemolysis. Plasma exchange has been used in patients with warm-antibody AIHA Anti-CD20 antibody: Rituximab can be used to treat refractory AIHA SCT (stem cells transplatation) Patients with primary warm-antibodies AIHA have unpredictable clinical courses characterized by relapses and remissions. The types of AIHA Evans syndroms RBC circulate in the peripheral blood for 100 to 120 days, and approximately 1% of the body’s red cells are lost and replaced each day. Anemia is functionally defined as an insufficient RBC mass to adequately deliver oxygen to peripheral tissue. For practical purposes, any of the three concentration measurements are used to establised the presence of anemia: Hb level, hematocrit(%)and RBC number. MCV: mean corpuscular volume MCH: mean corpuscular Hb MCHC: mean corpuscular concentration The 12th power to 10 * Sample Results Plasma or serum Free hemoglobin↑ # Methemoglobin ↑ Indirect bilirubin ↑ Haptoglobin↓ Lactate dehydrogenase↑ Urine Urobilinogen + Free hemoglobin + # Methemoglobin + Urine sediment Ferritin + Bone marrow Erythroid hyperplasia Whole blood RBC, Hb, Hct ↓ MCV(sometimes) ↑ Reticulocyte count ↑ Peripheral smear Polychromasia and morphology specific to underlying disease Feces Occult blood # Results particularly indicative of intravascular hemolysis A final diagnosis of one of the hemolytic anemia is established by a two-step process: First, demonstrating that a hemolytic anemia is present Second, determining the specific cause of the condition. Anemia with high R