Traumatic Physical Cell Injury

Cardiac Haemolytic Anaemia

  • Prosthetic heart valve
  • Surface of the valve can become roughened resulting in some intravascular haemolysis
  • Can become an iron deficient anaemia (haemoglobinuria)
Microcirculation Lesions
  • Conditions resulting in microangiopathic haemolytic anaemia (small vessels are either partially thrombosed, narrowed or have a malignancy associated with them
  • Intravascular haemolytic blood picture
 

Haemolytic Uraemic Syndrome (HUS)

  • Common in children from 5 months to 2 years of age
  • Affects renal blood vessels
  • Can also be associated with pregnancy and oral contraceptives
  • Presents with acute renal failure, thrombocytopaenia (because of coagulation) and intravascular haemolysis
  • Kidney endothelial cells are damaged, platelets adhere resulting in coagulation (disseminated intravascular coagulation, DIC-see below)
  • Fibrin tears RBCs apart
  • Kidney rehydration by peritoneal dialysis, blood transfusions and plasmapheresis may be used to help the sufferer

Thrombotic Thrombocytopaenic Purpura (TTP)

  • Often occurring spontaneously, mechanism unknown
  • May follow infection
  • More often seen in young females
  • Kidney failure but more widespread than in HUS with DIC if coagulation is activated extensively
  • Often develop neurological symptoms-poor prognosis
  • Intravascular haemolysis, microthrombi, thrombocytopaenic blood picture

Malignancies

      • Associated with the prostate, lung and stomach
      • Commonly associated with DIC

Thermal Injury

  • Burns (>48'C) cause considerable intravascular haemolysis
  • Occurs during the time cells take to traverse the heated area
  • Usually recover after 24 hours

Haemoglobinuria

Acute Haemoglobinuria

  • Incompatible blood transfusion
  • Haemolytic anaemia due to drugs or other chemical agents
  • Favism
  • Acute acquired haemolytic anaemia
  • Haemolytic anaemia due to infection
  • Blackwater fever
  • Acute haemolytic anaemia due to burns
  • Snake and spider bites

Chronic Haemoglobinuria

  • Paroxysmal nocturnal haemoglobinuria
  • Paroxysmal cold haemoglobinuria
  • Cold agglutinin haemoglobinuria with Raynaud's syndrome
  • March haemoglobinuria
    • Trauma to RBCs at surfaces of the hands and feet
    • Joggers, martial artists, severe exercise
    • Usually not life-threatening, no anaemia

Disseminated Intravascular Coagulation (DIC)

  • Release of thromboplastin-like substances from ruptured RBCs results in the activation of coagulation
  • F XII can react with exposed collagen via the intrinsic coagulation system
  • Obstruction of the microvasculature occurs resulting in infarction
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