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Hemolytic-uremic syndrome

(HUS)

Characterized by:
MAHA
Thrombocytopenia
Acute Renal Failure

From THROMBI formed mainly in the glomerular


microvasculature

Two general
types:

- D+ HUS

Atypical HUS

Acute gastroenteritis(bloody
diarrhea)
90% cases of HUS
Occurs mostly in young children
Infection with
enterohemorrhagic serotypes of
E. coli (0157:117)

No diarrhea
10% case of HUS
Commonly found in adults
Half are FAMILIAL and Half are
SPORADIC
-Mutation in
-occurs
genes
secondary to
some: drug
cancer
organ
transplantation

Microscopic findings in HUS

Schistocytes
Normocytic anemia
Increased reticulocyte count
polychromatophilia
Mild to moderate decreased in
platelets

Disseminated Intravascular Coagulation


(DIC)

Characterized by:
Widespread activation of hemostatic sytem
Resulting in FIBRIN THROMBI formation
throughout the microvasculature

Major Clinical Manifestation:


Organ damage due to
obstruction of the
microvasculature
Bleeding due to consumption
platelets
Coagulation factors
Secondary activation of
fibrinolysis

Conditions Associated With DIC:


Disseminated cancers,
Acute leukemias,
Infections,
Obstetric Complication,
Crush or brain injuries,
Acute hemolytic transfusion
reactions,
Extensive burns,
Chronic Inflammation

Microscopic findings in DIC

Fragments
Schistocytes
Paucity of platelets
Normocytic anemia
Increased reticulocyte count
polychromatophilia

Clostridia

Clostridial Sepsis
Sepsis with Massive Intravascular hemolysis
Cause by Clostridia Perfringens
Often fatal and is rare complication of infection
It hydrolyses the RBC membrane phospholipid by producing
alpha toxin with phospholipase C spingomyelinase activity
RBC becomes spherical and extremely susceptible to osmotic
lysis
Hematocrit may be 10%

Conditions that increased


the risk are:
Malignancies,
solid organ transplant,
post partum or post abortion
infections, and
deep wounds

Peripheral blood film:


Sphrerocytes,
microsphrerocytes and toxic
changes to neutrophil

Hemolysis
Due to Venoms, Chemicals,
and Drugs

Venoms
Can induce hemolysis through direct disruption of the RBCs
membrane , alteration of the RBC membrane and initiation of DIC
Caused by envenomation from contact with snakes, spiders, bees,
and wasps
Hemolysis occur acutely or be delayed one or more days after a
bite or stung
In severe cases it causes renal failure and death

Drugs and
chemicals
-oxidative denaturation of
hemoglobin
-leading to formation of
methemoglobin and
Heinz bodies

Laboratory findings:
-Decreased hemoglobin
-Decreased reticulocyte
-Increased serum indirect
bilirubin
-Decreased in serum
haptoglobin
-Heinz Bodies