Treating a pregnant patient



we often see patients with anemia and our clinical routine they present with symptoms such as paleness fatigue or tachycardia if anemia is only mild there might be no specific symptoms at all one of the differentials that is common in adults is hemolytic anemia so what lab findings can help you diagnose hemolysis if hemolysis is present you'll find elevated LDH elevated bilirubin reticulocyte ptosis a decrease in haptoglobin and if intravascular hemolysis is present you should see a significant elevation in free hemoglobin and hemoglobin urea once you see laboratory findings suggesting hemolytic anemia you should immediately consider the most common cause of hemolytic anemia adults autoimmune hemolytic anemia so what happens in autoimmune hemolysis basically antibodies that are directed against the individual's own red blood cell antigens so-called Auto antibodies attack the RBC's and cause them to burst the loss of functional red blood cells leads to anemia these Auto antibodies can be of different immunoglobulin classes IgG IgM or IgA in some cases the complement system is also activated why some individuals immune systems attack their own cells is not entirely understood 50% of all cases of autoimmune hemolysis are idiopathic so we just don't know why they happen the other 50% result from secondary causes diseases or conditions that are known to induce autoimmune hemolysis include neoplasms especially lymphoproliferative disorders like lymphoma or chronic lymphocytic leukemia but also other neoplasms autoimmune diseases like systemic lupus rheumatoid arthritis inflammatory bowel diseases and others infections by mycoplasma viral pneumonia or infectious mononucleosis or drugs like penicillin diclofenac or methyl dopa so how can I verify that the hemolysis I see is autoimmune to determine whether the hemolysis is of Ottoman nature the transfusion lab performs the direct anti globulin test dat for short to perform this test you need the patient's RBC's and antibodies that bind to IgG antibodies which are known as anti globulin antibodies or Coombs serum basically you want to verify that the patient's red blood cells have already been attacked by antibodies that cause hemolysis in order to do this you mix the patient's RBC's with the anti-global and antibodies and incubate them if the patient's RBC's are covered with IgG antibodies the anti-global in antibodies will bind to the IgG s on the RBC surface and agglutinate the RBC's agglutination can be seen microscopically in this case the direct anti globulin test is positive you are dealing with audio moon hemolysis the lab can go on to determine the specificity of the Auto antibodies and whether the complement pathway is activated these results plus a proper medical history help to narrow down the cause of the autoimmune process and lead the way to the best treatment option if there are no other antibodies on the patient's RBC's the anti globulin serum has nothing to bind to so there will be no agglutination the DAT is negative there must be a non autoimmune reason for hemolysis so keep on searching for differentials so does a positive deity always indicate an autoimmune process the answer is no a positive deity will not only indicate autoimmune hemolytic disease but also recent hemolysis caused by the incompatibility of red blood cell antigens and antibodies there are two possible reasons for the latter hemolytic transfusion reaction following incompatible blood transfusion and hemolytic disease of the newborn in these two cases RBC's might be covered with IgG antibodies as well however these would be yellow antibodies instead of Auto antibodies the deity will induce a cutie nation of discovered RBC's just the same so in these situations the deity helps you to show that Hamal is taking place right now autoimmune hemolytic anemia is an important differential and a workup of anemia the direct anti globulin test is a fast and cheap test to help you diagnose it furthermore it can help you determine how recent hemolytic processes are in situations of blood group incompatibilities like after an incompatible transfusion or in newborns affected with hemolytic disease of the fetus and newborn so I hope you like this video absolutely make sure to check out the course this video was taken from and to register for a free trial account which will give you access to selected chapters of the course if you want to learn how mat mastery can help you become a great clinician make sure to watch the about that mastery video so thanks for watching and I hope to see you again soon

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