The haematological emergency - Acute haemolysis - Calendar 2008 month 1

The increased synthesis of erythrocytes in the bone marrow results in an elevated number of reticulocytes (red and purple area) in the peripheral blood. It can be measured in the reticulocyte channel of the haematology analysers SYSMEX XE-5000, XE-2100 and XT-2000i. In this example the measured reticulocyte fraction was 7.9% (upper limit of the reference range: 2.1%). A better indicator of the increased erythropoiesis is the reticulocyte production index (RPI) which additionally considers haematocrit and reticulocyte maturation time.

Serum of the same patient as in the background figure at the time of hospitalisation (left) and 12 hours later (right): The serum is coloured red-brown due to intravascular haemolysis.

Autoimmune haemolytic anaemia (AIHA) in a case of chronic lymphocytic leukaemia (B-CLL): Reticulocytes are increased, spherocytes are present, Coombs’ test is positive.

Agglutinated erythrocytes and marked polychromasia in a patient with haemolytic anaemia caused by cryoglobulins in Waldenström’s macroglobulinaemia.