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Chapter-07 Hemolytic Anemia in Pregnancy

BOOK TITLE: Anemia in Pregnancy

Author
1. Aggarwal Kiran
ISBN
9788184482997
DOI
10.5005/jp/books/10044_7
Edition
1/e
Publishing Year
2008
Pages
30
Author Affiliations
1. Lady Hardinge Medical College and SSK Hospital New Delhi, India, Municipal Corporation of Delhi, Delhi, India, Lady Hardinge Medical College and SSK Hospital, New Delhi, Municipal Corporation of Delhi, Member, Child Welfare Committee, Delhi, India, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India, Hindu Rao Hospital, MCD, Delhi, D11/2, 14 Rajpur Road, Civil Lines, Delhi 110054, Hindu Rao Hospital; IAP Delhi, New Delhi, India, Hindu Rao Hospital, President IAP Delhi (2015) New Delhi, India
Chapter keywords

Abstract

Hemolytic disorders are conditions where life span of red blood cells is shortened and they are destroyed prematurely resulting in hemolysis. Breakdown of red blood cells causes release of hemoglobin and lactate dehydrogenase with rise in unconjugated bilirubin. Free hemoglobin binds to serum haptoglobin whose levels fall. With significant hemolysis, hemoglobinuria and hemosiderinuria occur. While evaluating a patient, a detailed history of symptoms of anemia, jaundice, gallstones, leg ulcers, infections and intake of drugs is important. Family history of splenomegaly, jaundice and enzyme deficiencies should be taken. Other conditions like chronic lymphocytic leukemia, lymphoma and SLE should be ruled out. Fall in hemoglobin with reticulocytosis, raised unconjugated bilirubin, elevated lactate dehydrogenase levels with fall in serum haptoglobin levels are most sensitive tests for hemolysis. Inherited hemolytic anemias are due to inborn defects in red blood cells at membrane level, enzyme deficiencies or defects in hemoglobin. Acquired hemolytic anemias may occur due to immune mechanisms or due to physical trauma because of direct injury to RBCs as they circulate through the vascular system. Other causes of hemolysis may include infections, drugs, paroxysmal nocturnal hemoglobinuria and pregnancy induced. Drugs can cause hemolysis by direct injury to the red blood cells. Drug induced hemolysis can occur by stimulation of antierythrocyte antibody formation as in alpha methyl dopa or by hapten induced damage as seen in hemolysis caused by Penicillin. Unexplained pregnancy induced hemolytic anemia is a distinct entity where severe hemolysis develops early in pregnancy and resolves within months after delivery. Infant may also show transient hemolysis. Maternal corticosteroid treatment is usually effective.

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