Hemolysis: Description, Causes and Risk Factors: HemolysisRed blood cells [RBCs] typically have a life span of 110-120 days. When they are destroyed prematurely it is called hemolysis. The bone marrow typically reacts by increasing the production of red cells to prevent the development of anemia. If the production cannot keep up with the rate of destruction, anemia develops. Hemolysis can be intravascular or extravascular. Intravascular hemolysis occurs very rarely and is usually the result of a transfusion reaction or hemolytic anemia. Extravascular hemolysis is quite common and means that the red blood cell is damaged as part of an external process, usually the venipuncture process used to obtain the specimen. Extravascular hemolysis can also be caused by mechanical manipulation (i.e., dialysis or heart/lung machine) or by over zealous mixing of the sample. Conditions that cause hemolysis include:
  • Immune reactions.
  • Infections.
  • Medications.
  • Toxins and poisons.
  • Treatments such as hemodialysis.
In vivo hemolysis can be caused by a large number of medical conditions, including many Gram-positive bacteria (e.g., Streptococcus, Enterococcus, and Staphylococcus), some parasites (e.g., Plasmodium), some autoimmune disorders, some genetic disorders (e.g., Sickle-cell disease or G6PD deficiency), or blood with too low a solute concentration (hypotonic to cells). Symptoms:
  • Jaundice - usually mild.
  • Fatigue.
  • Weakness.
  • Dizziness.
  • Diaphoresis.
  • Dyspnea.
  • Chest pain.
  • Leg cramps with exercise.
  • Abdominal fullness and discomfort.
Other signs include:
  • Jaundice.
  • Tachycardia.
  • Tachypnea.
  • Hypotension.
  • Splenomegaly.
Diagnosis: Diagnosis may include the following tests:
  1. Bilirubin level usually only mildly elevated (3 to 6 mg/dL) may be within normal range if mild.
  2. LDH elevated with hemolysis.
  3. CBC - evaluate for schistocytes and reticulocytes count; CBC usually increased; indicates increased erythropoiesis.
  4. Direct antiglobulin test (DAT, direct Coombs' test to detect the presence of IgG and complement (C3) on the RBCs; differentiates immune form non-immune hemolysis.
  5. LFTs and alkaline phosphatase usually within normal limits.
  6. Haptoglobin levels are decreased as protein binds hemoglobin.
  7. Urinalysis - elevated urobilinogen, even without hyperbilirubinemia.
Treatment: For mild symptoms no treatment may be needed. Monitor hemoglobin and the potential for transfusion. For more advanced symptoms, a steroid such as prednisone is the treatment of choice. For patients with an inadequate response to steroid, splenectomy may be an option. If symptoms continue after splenectomy, immunosuppressive therapy may be indicated with cyclophosphamide or azathioprine. Plasmapheresis is another option. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  


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