CH HemolyticAnemia

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Chronic Haemolytic Anaemia

 Personal history
‫ وليد محمود محمد‬male patient, 28 years old, manual worker, married and has 1 off spring, he
was born and now live in ‫ عين شمس‬, mild cigarette smoker, no other special habit of
medical importance.
 c/o
Pain in Lt. upper quadrant of abdomen of 2 weeks duration .
 HPI
The condition started since he was 12 years old by gradual onset, progressive course of
localized dull aching pain at Lt upper quadrant of the abdomen not related to position,
respiration, exercise or meal. The condition was associated with fever, chills, bony pain,
headache, with jaundice of acute onset, progressive course with dark urine with no
anorexia, nausea, vomiting, itching, cachexia, or fatty dyspepsia. Then the patient was
admitted to hospital and investigated by liver function test which was normal and CBC which
revealed severe anemia and the patient was advised to take regular Bl. Transfusion every 3
months.
At age of 25 y the patient re-experienced the same attack of fever, chills, headache,
bone pain, jaundice of acute onset, progressive course, dark urine, no anorexia, nausea,
vomiting, cachexia or fatty dyspepsia. he was admitted to hospital and advised to take blood
transfusion every month with some medication as folate, desferal.
The patient remained quiet well until 2 weeks ago when he re-suffered from dull aching
pain at lt. upper quadrant of abdomen of gradual onset, progressive course, not related to
position, exercise, meal, respiration
Apart from regular exertional palpitation ,there is no symptoms suggesting cardiovascular
system affection.
No history of other system affection
 Past history
No history of operations, drug known to cause haemolysis, common diseases (DM, HPN).
 Family history
- +Ve consanguinity.
- No Similar condition in family.
- No common diseases in family.
 General exam
- Temperature: 37o c.
- Bl. Pressure: 140/60.
- Pulse: 70 beat/minute, big pulse volume, equal in both side, with water hammer
pulse, blood vessels not felt, intact peripheral pulsation with no radio-femoral delay.
- Mentality: The patient is fully conscious, well oriented for time, place and person.
Average mood and memory. The patient is co-operative with average intelligence.
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- Built: Average Built.
Head & Neck: pallor, jaundice, mongoloid features.

UL: there is pallor in palmar creases. (now improved)
LL: there is pigmentation (may be ulcers specially in sickle cell anemia ).
 Local Examination
 By Inspection__
There is local swelling in Lt. upper quadrant of abdomen decreased by rising up test.
 Palpation__
By superficial palpation:
There is swelling in lt hypochondrium. no other swellings , rigidity or tenderness.
By deep palpation:
The liver is firm in consistency, sharp border, Rt. lobe is felt 2 finger under Rt. costal margin
in the right MCL, lt. lobe felt 3 fingers below xiphistemum in midline, with smooth surface no
tenderness, no pulsation.
The spleen is firm in consistency, rounded border, huge in size, smooth surface, not tender,
not pitted
no other palpable abd. Organs.
 Percussion__
- Upper border of liver is in Rt. 6th intercostal space by heavy percussion with hepatic
span is 16 cm at right MCL.
- There is dullness below Rt. costal margin, xiphisternum continuous with hepatic
dullness detected by light percussion.
- There is dullness exceeding umbilicus and continuous with traub's area dullness
detected by light percussion.
 By Auscultation of the heart_

There is accentuated 1st and 2nd heart sounds, soft systolic murmurs all over pericordium
(hemic murmurs) .
 Investigation
- HB electrophoresis: detect fetal Hb (HBF -->80-90%)
- CBC: hypochromic microcytic anemia, reticulocytosis.
- Target cell in blood film.
 Treatment
Avoid precipitating factor (if possible), Repeated Bl. Transfusion, Desferral, Folic acid.
 Diagnosis :
A case of hepato-splenomegaly for D.D most probably Ch. Heamolytic
aneamia most probably thalassemia major.

CH HemolyticAnemia

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Sheets www.1aim.

Chronic Haemolytic Anaemia

Head & Neck: pallor, jaundice, mongoloid features.

 By Auscultation of the heart_

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