SEC S20W5 || Haemolytic anaemias - Module 5

 

Hello my dear Steemians,

 

Today I wanted to take part in the challenge, the reasons? Due to my work I often come across of patients who by mistake referred to surgery with "Jaundice" as possible biliary source or to our neighbour speciality Urology with "Hematuria" or in sepsis we often then find the course that is completely different from surgical course but Haematological.

The other reason was that for this challenge I could combine two things:

• my medical knowledge from own practice, and
• my art skills to draw diagrams

The drawing skills of medical diagram is something that all the doctors develop while their work, because we have students who we need to explain in simple words anatomy but also we often speak to patient and their relatives in order to explain what they have and what we are going to do. That is why one of the diagram I simply made using colourful inks and also very simple drawing of heart.

 

Haemolytic Anaemias

 

Haemolytic anaemia is a condition when our red cells in blood stream start to break down earlier than their lifetime. The process of destruction of red cells is called hemolysis and that is a word that originates from old Greek language: “hemo” that means blood and “lysis” that means breaking or rupturing of blood cells. Normally each red cell lives about 120 days, but in the case of this anaemia it happens much faster.

The condition could be inherited but also it could be due to different conditions, infection, blood cancer, medication, overactive spleen. Without correct treatment in in time the affected person can develop severe health condition like irregular heart heats, cause enlargement of heart that will try to compensate that and also at long term cause heart failure.

 

Sickle Cell Anaemia (SCA)

 

 

This is a condition that inherited in the family and defined with an abnormal shape of blood cells that while flowing within the small blood vessels could be trapped in liver or spleen and destroyed. Majority of people who suffer from Sickle Cell Anaemia originate from Africa and Caribbean. SCA is transmitted with a gene given from parents to a child, there could be a situation when both parents do not have symptoms but their child has a disease.

Due to that abnormal shape of cells they are not able to carry out their role of bind oxygen and transport to throughout the body, the same time the cells are destroyed earlier both these condition lead to lack of oxygen and that could lead to:

• children to feel tired quickly when they run and play around

• they may notice shortness of breath

• sickle cell crisis, when the abnormal shapes cells block the vessels and prevent blood flow, that usually presents with chest pain, pain in arms, legs and joints. Those episodes can last for prolong time and might require admission to hospital

• the growing process of a child can be affected by this condition too

 

Extravascular vs intravascular hemolysis

 

Extravascular haemolysis means what the name says: extra- outside and vascular- vessels. That means that the process of destroying of red cells happens outside of vessels and there are two main organs: liver and spleen. Our body is so build that once there is an abnormal cell it will be filtered and removed from the body and that is a great function to keep our body functioning normal. The abnormal red cells have a certain shape or carry a certain Immunoglobulin antibodies that will be efficiently removed from the body in those two organs.

Intravascular haemolysis also the meaning can be drawn from the words: intra-inside and vascular- vessels. That means that process of destroying the red cells happen within the blood vessels. The condition often caused by infection, septic shock with disseminated intravascular coagulation that leads to haemolysis. Autoimmune condition when our immune system by mistake attacks our own cells considering them for foreign. Another interesting phenomenon that could happen when soldiers are marching for a long distance or time, due to mechanical trauma while marching the blood cells can be destroyed within vessels. Also, due to heart valve replacement especially when there is a mechanical valve that also can destroy the blood cells and cause haemolytic anemia

 

A case of haemolytic anaemia

 

I wanted to bring this case, because for many without medical background it will be easy to understand. A 53 year old patient was referred to Urology with blood in urine but also with shortness or breath, lack of energy, looking slightly pale and a bit jaundice. He had previous heart valve replacement too few years ago. His symptoms thought to be originating from loosing blood with urine and patient underwent a camera test for bladder but no source of bleeding was found. He was given blood transfusion and iron tablet and sent back to GP (general Practitioner).

The patient still was feeling tired and fatigued, he then was referred to Endoscopy of upper Gastrointestinal tract that showed only mild inflammation. Patient was given some stomach protection tablets. Repeat bloods by GP showed persistent haemolytic anaemia and this time in blood smear it was noted fragmented red cells, increase reticulocytes that is a marker of Bone marrow compensation of short lifetime of red cells.

That is why then GP thought about mechanical heart valve that could be potential cause of damage to red cells. Further investigation showed that due to patient’s worsening of enlargement of one of the heart chamber there was more backflow of blood and the valve was not sealing properly causing turbulence around valve and mechanical damage of red cells. In those cases a new heart valve can sort out the problem with anaemia and patient could recovery well from anemia.

 

 

Here I wanted to show how the artificial valve is sitting and will be looking like, it is a case of replacement of valve between left upper and lower chambers.

 

 

 

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I would like to invite @suboohi, @iqrarana786 and @sammy1109 to this challenge

 

 

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