This patient had a complicated presentation and history with prolonged malaria, schistosomes, drug treatment, haemolytic anaemia, thrombocytopenia and lupus anticoagulant.
Quinine-induced haemolytic anaemia has been reported in patients with G6PD deficiency, and cardiac arrhythmia in patients who are elderly or have pre-existing cardiovascular disease.
TTP should be considered in all patients presenting with signs of micro-angiopathic haemolytic anaemia, thrombocytopaenia, fever, renal and liver dysfunction, and fluctuating neurological signs.
Patients with a falling Hb on AZT (or AZT-containing regimen) should be investigated for other causes of anaemia, usually nutritional or infective, but autoimmune haemolytic anaemia should also be considered.
Red blood cell transfusion in warm-type autoimmune haemolytic anaemia.
Her blood film showed fragmented red cells, which suggested the diagnosis of microangiopathic haemolytic anaemia.
Both patients subsequently developed renal failure with associated anaemia, thrombocytopenia and red cell fragmentation consistent with microangiopathic haemolytic anaemia.
IMMUNE mediated haemolytic anaemia
(IMHA) is where the body's immune system attacks and destroys its own red blood cells (that carry oxygen in the blood) or platelets (that help with clotting).
The pathophysiology, clinical presentation and management of drug-induced immune haemolytic anaemia and oxidative haemolysis will be discussed separately.
Haemolytic anaemia occurs when the pace of red blood cell production does not match red cell destruction, either because red cell survival is extremely short or because the bone marrow is unable to compensate (e.