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MLAB 1415: HematologyMLAB 1415: HematologyKeri Brophy-MartinezKeri Brophy-Martinez
The HemoglobinopathiesPart One
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Hemoglobinopathies?Hemoglobinopathies?What are they?
◦Disorders where the production of normal adult hemoglobin is partly or completely suppressed or replaced by a variant hemoglobin.
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HemoglobinopathiesHemoglobinopathiesCatagories
◦Inherited abnormality of the structure of one of more of the globin chains
◦Inherited abnormality related to the rate of synthesis of one or more of the globin chains
◦Failure of the normal switch from fetal hgb (HbF) to adult hgb (HbA)
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Broad Classification System for Broad Classification System for Hemoglobin DisordersHemoglobin Disorders
Qualitative:◦ Hemoglobins differ in sequence of amino acids
composing globin chain ◦ Structural defect◦ Disorders called hemoglobinopathies
Quantitative:◦ Characterized by decreased rate of hemoglobin
production◦ Amino acid sequence NOT altered ◦ Called thalassemia
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Qualitative Disorders Qualitative Disorders
Qualitative abnormalities in globin structure, usually involving beta-chain.
Heme portion is normalArise from single amino acid substitution or
deletion◦ Rarely see multiple substitutions.
May or may not cause abnormal laboratory test results.
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Sickle Cell Sickle Cell Anemia andAnemia andSickle Cell TraitSickle Cell Trait
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Introduction to Sickle Cell Introduction to Sickle Cell AnemiaAnemia
Most common hemoglobinopathy
Autosomal co-dominant
Hemoglobin A and Hemoglobin S produced. AS is sickle cell
trait. SS is sickle cell
disease. Patient is homozygous for HbS (SS). Results in very severe anemia.
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FrequencyFrequencyAfrican Americans
◦Sickle cell disease occurs in 1 in 375 live African American births
◦Sickle cell trait occurs in 20-40%Is worldwide disorder
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How and Why Cells SickleHow and Why Cells SickleHb S forms from a point mutation
for the sixth amino acid in the Beta chain.
Valine substituted for glutamic acid.
One benefit for AS persons is increased resistance to malaria
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Pathophysiology Pathophysiology of Sickle Cell Anemiaof Sickle Cell Anemia
SS cells may look normal when fully oxygenated; Sickling occurs when O2 decreased.
Other causes of sickling include decrease in pH
and dehydration of patient.
Cells become rigid, impeding blood flow to tissues. Tissue death, organ infarction, and pain result.
Sickling is reversible up to a point. Have both extravascular hemolysis and
intravascular hemolysis.
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Clinical FindingsClinical Findingsof Sickle Cell Anemiaof Sickle Cell Anemia
Clinical signs appear at 6 months of age
Have all physical symptoms of anemia Growth and sexual maturation slowerCrisis – very painful. Anything that
deoxygenates blood acts as trigger (exercise, illness and airplane flights). Sickle cells get stuck in capillaries.
Strokes
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Sickle Cell Anemia: Clinical Sickle Cell Anemia: Clinical featuresfeatures
Organs Affected:◦Liver: Enlarges, malfunctions, jaundice, hyperbilirubinemia◦Heart: Cardiomegaly, iron deposits◦Spleen: Enlarges leading to infarction and fibrosis Eventually shrivels
and becomes nonfunctional◦Skin: Develop ulcers, jaundice◦Kidney: Hematuria and eventual failure ◦Lungs: Infarction ◦Brain: Strokes◦Blood: Hemolytic anemia◦Bones: painful crisis
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Pathophysiology Pathophysiology of Sickle Cell Anemiaof Sickle Cell AnemiaHave three
types of crises:◦ Aplastic crisis:
associated with infections which causes temporary suppression of erythropoiesis.
◦ Hemolytic crisis: Results in exaggerated anemia.
◦ Vaso-occlusive crisis: Associated with severe pain. Hallmark symptom of sickle cell anemia.
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Peripheral Blood Findings in Sickle Peripheral Blood Findings in Sickle Cell AnemiaCell Anemia
Hb 6-10 g/dL Normocytic, normochromic
anemia Marked aniso and poik Sickle cells and Target cells NRBCs with Polychromasia Increased Retics Basophilic Stippling Howell Jolly Bodies and
Pappenheimer Bodies Leukocytosis with left shift Thrombocytosis
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Special Hematology Tests Special Hematology Tests in Sickle Cell Anemiain Sickle Cell Anemia
Hemoglobin Electrophoresis ◦Use either alkaline/acid mediums to
separate individual hemoglobinsHemoglobin Solubility Test-
Positive Osmotic Fragility – Decreased Sed Rate – Decreased
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Chemistry TestsChemistry Testsin Sickle Cell Anemiain Sickle Cell Anemia
LDH increased Bilirubin – increasedHaptoglobin decreased
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Sickle Cell Anemia: Treatment
Prevention of infectionReduce organ damage
◦Hydroxyurea (it is believed to induce production of Hgb F). Using chemotherapeutic agents
◦Avoidance of situations that could cause a crisis
Minimize pain• Blood transfusion
Median life expectancy- 50 years
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Sickle Cell TraitSickle Cell Trait
Heterozygous AS with more HbA than HbS, so condition is compensated for
Patient often has normal life spanUsually asymptomatic with occasional
episodes of hematuria◦ Sickling can occur with drastic reduction of
oxygen tension such as severe respiratory infection, air travel in unpressurized aircraft, anesthesia or congestive heart failure
◦ Exercise that causes a buildup of lactic acid can cause sickling due to lowered pH
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Laboratory Features:Laboratory Features: Sickle Cell Trait Sickle Cell Trait
Normal CBC – Few target cells Hemoglobin solubility test –
positive Electrophoresis – Both A and S
present
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ReferenesReferenesMcKenzie, S. B. (2010). Clinical Laboratory
Hematology (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc.
http://learn.genetics.utah.edu/content/disorders/whataregd/sicklecell/