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Diagnostic Evaluation Hemolytic anemia

  • Hemolytic anemia is a condition where red blood cells (RBCs) are destroyed faster than they can be replaced.
  • The diagnosis of hemolytic anemia is based on the following tests:
    • Complete blood count (CBC) and reticulocyte count: CBC measures the number, size, and shape of RBCs, white blood cells (WBCs), and platelets. Reticulocyte count measures the percentage of immature RBCs in the blood. Hemolytic anemia is indicated by low hemoglobin (Hb), low hematocrit (Hct), normal or high mean corpuscular volume (MCV), and high reticulocyte count. Normal ranges for Hb are 13.5-17.5 g/dL for men and 12-16 g/dL for women. Normal ranges for Hct are 40-54% for men and 36-48% for women. Normal range for MCV is 80-100 fL. Normal range for reticulocyte count is 0.5-1.5%.
    • Peripheral blood smear: This test examines the appearance of RBCs under a microscope. Hemolytic anemia may show abnormal shapes of RBCs, such as spherocytes, sickle cells, or schistocytes.
    • Serum bilirubin and haptoglobin: Bilirubin is a yellow pigment that is produced when RBCs are broken down. Haptoglobin is a protein that binds to free hemoglobin in the blood. Hemolytic anemia causes high levels of bilirubin and low levels of haptoglobin. Normal range for bilirubin is 0.3-1.2 mg/dL. Normal range for haptoglobin is 30-200 mg/dL.
    • Lactate dehydrogenase (LDH): LDH is an enzyme that is released when cells are damaged. Hemolytic anemia causes high levels of LDH in the blood. Normal range for LDH is 140-280 U/L.
    • Direct antiglobulin test (DAT) or Coombs test: This test detects antibodies or complement proteins that are attached to the surface of RBCs. A positive DAT indicates immune-mediated hemolysis, such as autoimmune hemolytic anemia or transfusion reaction.

Questions on Diagnostic Evaluation Hemolytic anemia

Correct Answer is B

Explanation

Mechanical trauma is not the primary reason for developing hemolytic anemia. While physical trauma can lead to the rupture of red blood cells (e.g., in cases of traumatic hemolysis), it is not the primary cause of hemolytic anemia. This choice is incorrect.

Correct Answer is D

Explanation

This is the correct answer. Hemolytic anemia results in the destruction of red blood cells due to oxidative stress. Red blood cells are exposed to oxidative damage, which leads to their premature destruction in the bloodstream, causing anemia.

Correct Answer is ["A","C","E"]

Explanation

Higher susceptibility to infections is a potential complication of hemolytic anemia. The destruction of red blood cells can weaken the immune system and make the individual more susceptible to infections. This choice is correct.

Correct Answer is B

Explanation

Increased ferritin levels. Increased ferritin levels are not a specific clinical manifestation of intravascular hemolysis. Ferritin is a marker of iron storage in the body and is not directly related to the destruction of red blood cells.

Correct Answer is D

Explanation

"Bilirubin is conjugated in the liver and excreted in bile." This is the correct answer. Bilirubin is produced from the breakdown of heme in red blood cells and is then processed in the liver, where it is conjugated (combined with glucuronic acid) to form conjugated bilirubin. Conjugated bilirubin is excreted in bile and eventually eliminated from the body in feces.

Correct Answer is A

Explanation

<p>&quot;I have been having severe headaches and chest pain.&quot; Severe headaches and chest pain are not specific clinical manifestations of hemolytic anemia. These symptoms may have other causes and should be evaluated separately.</p>

Correct Answer is B

Explanation

The absence of abnormalities in the peripheral blood smear does not rule out hemolytic anemia. Some forms of hemolytic anemia may not show distinct abnormalities in the appearance of red blood cells on a peripheral blood smear.

Correct Answer is ["A","C","D","E"]

Explanation

Immune-mediated hemolytic anemia can result in the production of autoantibodies that attack red blood cells, leading to changes in their structure and function.

Serum bilirubin and haptoglobin levels can provide indirect evidence of hemolysis, but they do not confirm the presence of immune-mediated hemolysis or identify the underlying cause.

The statement, "My hemoglobin level falls within the expected range," is incorrect. Hemolytic anemia typically results in low hemoglobin levels due to the destruction of red blood cells. This statement indicates a need for further education as it reflects a misunderstanding of the laboratory results

The statement, "My family has a history of hemolytic disorders," is the most crucial aspect of the patient's history to prioritize. Hemolytic disorders often have a genetic component, so family history can provide valuable information for diagnosis and management.

The statement, "I've been experiencing abdominal pain," is important to assess, but it is not a specific physical examination finding related to hemolytic anemia. Abdominal pain can have various causes, and further evaluation is needed to determine its association with the patient's condition.

Instructing the patient to "Report any jaundice or dark urine to your healthcare provider" is crucial because jaundice and dark urine are common signs of hemolysis in hemolytic anemia. These symptoms indicate an increased breakdown of red blood cells and should be promptly reported to the healthcare

Advising the patient to avoid physical activity is not a specific nursing intervention for hemolytic anemia. While excessive physical activity may exacerbate symptoms, it is not a primary intervention for preventing complications associated with the condition.

"To improve tissue oxygenation" is not the primary purpose of corticosteroids in the treatment and management of hemolytic anemia. While corticosteroids may indirectly improve tissue oxygenation by reducing hemolysis, their primary role is to modulate the autoimmune response and reduce the destructi
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