Chapter 6 Haemolytic anaemias

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6.1 Spherocytes in the blood film are a feature of which ONE of the following conditions?

A Thalassaemia major

Target cells are more typical.

B Autoimmune haemolytic anaemia

C Reticulocytosis

Polychromasia is characteristic.

D Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Heinz bodies are commonly associated with G6PD deficiency, with ‘bite’ cells noted during acute
haemolytic episodes.

6.2 Which ONE of the following is a typical feature of a chronic extravascular haemolytic
anaemia?

A Raised serum conjugated bilirubin

Bilirubin from haemolysis is mostly unconjugated.

B Low reticulocyte count

In the presence of a healthy marrow that can respond adequately, reticulocytes are typically raised because
of the chronic anaemia.

C Hypocellular bone marrow

The cellularity is usually increased, compensating for the anaemia.

D Risk for gallstones

Pigment gallstones are commonly observed with chronic haemolysis.

6.3 Which ONE of the following is a cause of intravascular haemolysis?

A Thalassaemia major

This typically causes extravascular haemolysis, mostly in the spleen.

B Transfusion of an ABO-incompatible red cell unit

C Autoimmune haemolytic anaemia

This is usually extravascular and antibody mediated.

D Rh incompatibility between donor and recipient

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 This causes extravascular (cells are destroyed in the spleen) haemolysis.

6.4 Which ONE of the following is a typical feature of intravascular haemolysis?

A Positive Coombs test

Typically seen in autoimmune causes (extravascular).

B Haemosiderin in urine

C Elevated haptoglobin level

Haptoglobin can be reduced in all forms of haemolysis, but especially intravascular.

D Raised serum bilirubin

This is usually normal.

6.5 Which ONE of these statements is TRUE regarding hereditary spherocytosis?

A It is caused by an inherited defect in haemoglobin

It is a membrane defect.

B It is more common in males

It is autosomally inherited in most cases and approximately equal between the sexes.

C It can be treated by splenectomy

Splenectomy can be beneficial, although it is not needed in all cases.

D It is more frequently encountered in southern than northern Europe

The incidence is higher in northern Europe.

6.6 Which ONE of the following statements is TRUE about autoimmune haemolytic anaemia?

A It may be due to beta-blocker drugs

These are not drugs that cause it.

B It is associated with pernicious anaemia

Pernicious anaemia is associated with autoimmunity, but usually for thyroid and other organs, not
haemolysis.

C It is frequently associated with immunoglobin (Ig) A autoantibodies in serum

Usually it is driven by IgG or IgM autoantibodies.

D It may complicate B-cell chronic lymphocytic leukaemia

E It commonly complicates malaria

Parasitic infections usually cause intravascular haemolysis that is non-immune mediated.

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 Which ONE of the following statements is TRUE about glucose-6-phosphate
6.7 dehydrogenase (G6PD) deficiency?

A It usually presents as a chronic haemolytic anaemia

This can happen but is a rare presentation.

B Certain foods are the most common precipitant of haemolysis worldwide

Infection is the most common precipitant, followed by drugs.

C Deficiency provides some protection against types of Clostridium infection

It protects against malaria, especially Falciparum, not other organisms.

D Carrier females have approximately 50% of normal G6PD levels

E Sulphonamides, e.g. Septrin, are safe to administer in patients with this deficiency

These drugs can cause haemolysis and are contra-indicated.

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