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Hemolytic Anemia

Hemolytic anemia is a kind of anemia that occurs when there is high rate of destruction of RBC. Infections of Streptococcus or other conditions can lead the body to destroy its own RBC. Hemolytic anemia can enlarge the spleen that results in increased destruction of red blood cells (Hemolysis). Some complications of this Anemia:
Pain
Shock
Gallstones


Persons suffering hemolytic condition might experience severe fatigue, dizziness, shortness of breath and chest pain. A complete blood count can help in identifying hemolytic anemia. Hemolytic anemia is treated with lifestyle changes and medicines. In more severe cases blood transfusion and plasmapheresis might be resorted to.


Autoimmune Hemolytic Anemia : Warm antibody hemolytic anemia, one of the most common types afflicting women, results when the body produces auto antibodies that coat red blood cells which in turn are destroyed by the spleen, liver or bone marrow. Many of these patients also have leukemia, lupus, lymphoma or connective tissue disease. In cold antibody hemolytic anemia, the body targets red blood cells at or below normal body temperature - often to patients who have had pneumonia, mononucleosis or other acute infections. Exposure to cold temperatures can accelerate red blood cell destruction resulting in fatigue, discoloration of limbs and joint pains.


Sideroblastic Anemia: In this anemia, the body has sufficient iron but it fails to incorporate it into hemoglobin.


Zieve's Syndrome

A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.


This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.


Symptoms

Most common symptoms due to long-term history of chronic alcoholism include:

Nausea
Vomiting after heavy drinking
Anorexia
Abdominal pain
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.


Causes of Zieve's Syndrome

Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.


Diagnosis of Zieve's Syndrome

The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.

Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.


Treatment

Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.



Reticulocyte Count Test

Blood is a precious fluid. Plasma, white blood corpuscles and red blood corpuscles are the three kinds of cells in the blood. The blood cells are normally made in the bone marrow. To know the level of red blood cells in the blood, reticulocyte count test is done.


Reticulocyte Count Test

Reticulocyte are immature red blood cells made by the bone marrow. Reticulocytes are in the blood for two days before developing into mature cells. Reticulocyte count test is done to determine if red blood cells are being made in the bone marrow at an appropriate rate. The count indicates how quickly reticulocytes are being produced and released by the bone marrow.


Need for Reticulocyte count test

Paleness, tiredness, weakness, shortness of breath, and/or blood in the stool are symptoms when doctors recommend Reticulocyte count test to:


  • Assess the functioning of bone marrow i.e. if enough red blood cells are made by the bone marrow.
  • Diagnose and distinguish the different kinds of anemia and the reasons for anemia, if it is due to fewer red bloods or due to great loss of red blood cells.
  • Evaluate reasons for chronic bleeding and or/blood in the stool.
  • Monitor progress after chemotherapy, bone marrow transplant, treatment for iron deficiency etc.
  • Determine the degree and rate of increased number of RBCs and elevated hemoglobin (rare occurrence) and hematocrit.

Reticulocyte count test - Preparation

There isn't any specific preparation required before Reticulocyte count test. However, it is recommended to check with health care provider if any specific pre test preparation is needed. Those who have had a recent blood transfusion should inform the doctor. This can affect test results. Important information to be shared with the doctor is about medicines being taken. Women who are pregnant and mothers who are breastfeeding infants should talk to doctor before opting for the test.


Reticulocyte count test Method

The test result is available few hours after collecting blood or the next day. An elastic band is wrapped around the upper arm to stop the flow of blood. Sample of blood from the vein of the arm is taken. A drop of blood is placed on a slide, smeared, stained and is examined under a microscope. This is the manual method. Automated methods that allow for greater number of cells to be counted are most likely to replace the manual method.


Reticulocyte count test result Interpretation

The number of reticulocytes is compared to the total number of red blood corpuscles (RBC) and is reported as a percentage of reticulocytes.

Reticulocyte (%) = [Number of Reticulocytes / Number of total Red Blood Cells] X 100

In a healthy adult person, the normal range is 0.5% to 1.5%. In kids, the normal range is 3% to 6%. This is a stable percentage. The normal range may slightly vary.


High reticulocyte count suggests more red blood cells are being made by the bone marrow. This could be due to acute bleeding, chronic blood loss, hemolytic anemia, kidney disease and potentially a fatal blood disorder in the fetus or new born - erythroblastosis fetalis (Erythroblastosis Fetalis refers to a serious blood disorder in infants - Rh incompatibility disease and ABO incompatibility disease) or hemolytic disease. Also, the count increases post treatment for certain anemia like iron deficiency anemia, pernicious anemia, or folic acid deficiency anemia.


Erythroblastosis Fetalis refers to a serious blood disorder in infants - Rh incompatibility disease and ABO incompatibility disease. Low reticulocyte count suggests fewer red blood cells are being made by the bone marrow. This can be due to aplastic anemia or iron deficiency anemia. Other instances such as exposure to radiation, a chronic infection or due to intake of certain medicines (drug toxicity) can lead to low count.

The reticulocyte count increases temporarily during pregnancy. The count is high in newborns but within few weeks the count drops to adult levels. In case the result is abnormal more tests may be administered for further analysis.


Tags: #Hemolytic Anemia #Zieve's Syndrome #Reticulocyte Count Test
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Collection of Pages - Last revised Date: February 25, 2020