Gestalt impression ha

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الـ Direct يستخدموه عادةً حتى يشوفون إذا الشخص عنده hemolysis لو لا (autoimmune hemolysis مثلًا).

الـ Indirect غرضه هو screening & prevention بالدرجة الأُولى.

There are some general features of hemolysis and other specific features that help to identify the reason for hemolysis. General features of hemolysis are:

• Decreased hemoglobin level.
• Increased unconjugated bilirubin.
• Increased LDH. This is because RBCs lack mitochondria and must rely on anaerobic respiration to obtain energy.
• Increased reticulocyte count.

The red cells may give an indication of the likely cause of the hemolysis:

• Spherocytes are small, dark red cells that suggest autoimmune hemolysis or hereditary spherocytosis.

• Sickle cells suggest sickle-cell disease.

• Red cell fragments (schistocytes) indicate microangiopathic haemolysis, such as TTP, DIC, and HUS.

• Bite cells (normal-sized red cells that look as if they have been partially eaten) suggest oxidative hemolysis. They contain Heinz bodies, which attract macrophages to eat them.

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The compensatory erythroid hyperplasia may give rise to folate deficiency, with megaloblastic blood features.

March hemoglobinuria is when vigorous exercise, such as prolonged marching or marathon running, can cause red cell damage and hemolysis in the capillaries of the feet.

Meningitis : inflammation of the meninges.

Blood examination usually shows anemia with a normal or raised MCV. The leukocyte count may vary from as low as 1×10^9/L to as high as 500×10^9/L or more. In the majority of patients, the count is below 100 × 10^9/L. Severe thrombocytopenia is usual but not invariable. Frequently, blast cells are seen in the blood film but sometimes the blast cells may be infrequent or absent. A bone marrow examination will confirm the diagnosis.
The bone marrow is usually hypercellular, with replacement of normal elements by leukemic blast cells in varying degrees (but more than 20% of the cells). The presence of Auer rods in the cytoplasm of blast cells indicates a myeloblastic type of leukemia.

Management:
The first decision must be whether or not to give specific treatment to attempt to achieve remission. This is generally aggressive, has numerous side-effects, and may not be appropriate for the very elderly or patients with serious comorbidities. In these patients, supportive treatment can effect considerable improvement in well-being.

There are 3 phases of the specific therapy for acute leukemia:

• Remission induction: remission is induced via a combination chemotherapy which causes severe bone marrow hypoplasia that lasts about 3-4 weeks and requires intensive support.

• Remission consolidation: more courses of chemotherapy, and more hypoplasia. Sometimes this phase includes allogeneic HSCT (Hematopoietic Stem Cell Transplant).

• Remission maintenance: this is done in outpatient setting and may last for 3 years.