張貼日期：2017/8/27 上午 02:09:57
Evidence of hemolytic anemia:↑RPI(+/-)、↑LDH(+/-)、↓Haptoglobin(+/-)
[PE]
Sclera: icteric(-)
Abdomen: hepatomegaly(-), splenomegaly(-)
---Classification---
Lifelong anemia(+/-): favor "hereditary or acquired" hemolytic anemia
Intravascular/Extravascular hemolysis
Intravascular hemolysis(usually IgM) evidence:
- ↑LDH(+/-)、Haptoglobin↓(+/-)、U/A Hemoglobinuria(+/-)
Extravascular hemolysis(usually IgG) evidence:
- Splenomegaly(+/-)
Immune-mediated hemolytic anemia evidence: direct Coombs test(+/-)、indirect Coombs test(+/-)
- Autoimmune:
Warm type(佔48-70%): Coomb's monospecific test indicate IgG+C3 related()
causes: preceding viral infection, autoimmune disease, lymphoproliferative disorder(須積極排除), drugs, allogenic blood transfusion, pregnancy(-)
Cold type(佔16-32%): Coomb's monospecific test:C3(), IgG(-), cold hemagglutinin(+/-), Cryoglobulin(+/-)
PE: distal limbs hypoperfusion sign(+/-)
causes: infection(mycoplasma, viral), lymphoproliferative disorder(須積極排除)
IgA mediated(較少見): 可以是warm or cold type
PB smear: Macro-spherocytosis(+/-)、Schistocyte(+/-)
Non-immune related hemolytic anemia
Fragment RBC syndrome
- CV: Cardiac valve(+/-)、Vascular abnormality(+/-)、Mechanical device(+/-)
- MAHA: TTP(+/-)、HUS(+/-)、DIC(+/-)
Infection(+/-)
PNH(+/-)
Hypersplenism(+/-)
Congenital(少見) causes: RBC membrane/skeletion defect(+/-), RBC enzyme abnormality(+/-), Hemoglobinopathy(+/-)
PB smear: Schistocyte(+/-)
Impression:
Plans:
1. 請緊急檢查室做PB smear
2. Survey AIHA etiology: review viral infection, drug history, survey lymphoma, check autoimmune profiles
3. Check reticulocyte count, serum iron, ferritin, TIBC, Bil-T/D, LDH, haptoglobin, indirect Coomb's test, Profile of Coombs’ poly-specific and monospecific DAT, Cold hemagglutinin, Cryoglobulin, G-6-PD(記得刪掉已驗過的)
4. Give pulse steroid as solu-medrol 250-1000 mg IV QD for 1-3 days
5. Give predonine 1-1.5 mg/kg/day, then taper according to the response in 1-3 weeks (goal < 20mg/day for 1 month as maintenance, then 20mg QOD)