Page 36 - Anemia Hemolitica No autoinmune

Causes of Red Blood Cell Fragmentation Hemolysis
Differential Diagnosis
Generally, the differential diagnosis of fragmen be deduced from the clinical findings. The pr heart valve or a regurgitant jet that fragmen Waring blender syndrome) can be readily di picture of thrombotic thrombocytopenic purp syndrome (TTP–HUS) is generally dramatic a 136). Atrioventricular malformations may be and platelet removal; the diagnosis requires a h and imaging studies. The presence of preecla woman with microangiopathic hemolysis usua HELLP (hemolysis, elevated liver enzymes, an syndrome is a serious complication of pregn without other signs of preeclampsia or hyperte can produce hepatic rupture, visual failure, DI gestive heart failure and requires treatment by p fetus. Cancer can be an underlying cause of mi supplying malignant tumors are thought to be They exhibit the same sort of fibrin stranding th tation hemolysis in DIC and TTP–HUS.
Continued use of invasive diagnostic and t with insertion of foreign bodies into the circu plicated by microangiopathic hemolysis. A tra portosystemic shunt can cause the syndrome i of patients. The hemolysis usually disappears Similarly, use of coil embolization to seal off a sus may also cause significant hemolytic anem been implicated as a cause.
Multiple drugs are associated with microa most commonly quinine.2 Cyclosporine, tacrol C have been implicated as causing an HUS develops within weeks to months of exposure. and bone marrow transplantation also are asso giopathic hemolysis. Both chemotherapeutic cancer agents, including immunotoxins, mono
Damaged microvasculature
Thrombotic thrombocytopenic purpura–hemolytic uremic
syndrome (TTP–HUS)
Associated with pregnancy: preeclampsia or eclampsia;
hemolysis plus elevated liver enzymes plus low platelets
(HELLP syndrome)
Associated with malignancy, with or without mitomycin C
treatment
Vasculitis: polyarteritis, Wegener granulomatosis, acute
glomerulonephritis, or Rickettsia-like infections Systemic lupus erythematosus
Abnormalities of renal vasculature: malignant hypertension,
acute glomerulonephritis, scleroderma, or allograft rejection
with or without cyclosporine treatment Disseminated intravascular coagulation Malignant hypertension
Catastrophic antiphospholipid antibody syndrome Atrioventricular malformations
Kasabach-Merritt syndrome
Hemangioendotheliomas
Atrioventricular shunts for congenital and acquired conditions
(e.g., stents, coils, transjugular intrahepatic portosystemic
shunt, Levine shunts) Cardiac abnormalities
Replaced valve, prosthesis, graft, or patch
Aortic stenosis or regurgitant jets (e.g., in ruptured sinus of
Valsalva)
Drugs: cyclosporine, mitomycin, ticlopidine, clopidogrel,
tacrolimus, or cocaine
Systemic infection: bacterial endocarditis, brucellosis,
cytomegalovirus, HIV, ehrlichiosis, Rocky Mountain spotted fever