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A rare, acquired hemolytic stem cell disorder.

Immune Hemolytic Anemia.

PNH is an uncommon disorder of unknown frequency both in the United States and worldwide. It is estimated that it is observed 5-10 times less than with aplastic anemia. It may be more frequent in Southeast Asia and the Far East. The disease process is insidious and has a chronic course, with a median survival of about 10 years. The morbidity is influenced by the importance of the hemolysis, bone marrow failure, and thrombophilia. Men and women are affected equally and the onset begins in childhood (<2 years of age) to adulthood (as old as 85 years of age). Other complications include infections and thrombosis.

Hemopoietic stem cell disorder leads to the production of defective platelets, granulocytes, and RBCs. The hemolysis might be triggered by acidosis during sleep. The RBCs have increased sensitivity to complement-mediated hemolysis as a result of deficient decay-accelerated factor. Platelets, too, are more sensitive to complement activation.

Laboratory diagnosis is based on the Ham test, which mixes affected RBCs with slightly acidified, but otherwise normal, serum. This leads to complement-mediated hemolysis.

Chronic hemolysis, anemia, pancytopenia, potentially life-threatening thrombosis secondary to platelet activation, low serum haptoglobin, elevated lactate dehydrogenase, hemosiderinuria, intermittent hemoglobinuria, especially when urine is concentrated, and normal peripheral smear, ± steroids.

Check hematocrit, anticipate need for transfusion. Check prothrombin time if the administration of anticoagulant is considered against thrombosis.

Maintain oxygen-carrying capacity. Avoid regional anesthesia if the patient is anticoagulated or if thrombocytopenia is present.

Steroid supplementation is highly recommended.

Kjaer K, Comerford M, Godalla F: General anesthesia for cesarean delivery in a patient with paroxysmal nocturnal hemoglobinuria and thrombocytopenia. Anesth Analog 98:1471, 2004.  [PubMed: 15105233]
Tabbara IA: Hemolytic anemias diagnosis and management. Med Clin North Am 76(3);649, 1992.

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