08 Hemolysis Basics

Hemolysis

• fewer red cells but same shape

• non hemolytic: underproduction of bone marrow

Reticulocytes

• left: low retic

• right: high retic

• lower Hct: retic will rise simply because more of them compared to Hct. Does not need increased production

Intravascular and Extravascular

• location of hemolysis

• hemolytic disorders in which shape of RBC's abnormal: increased removal

Haptoglobin

Labs

LDH, Bilirubin

• RBC: no mitochondria, no oxidative phosphorylation, no acetyl coa step, can only make lactate via LDH

• heme released from hemolysis

• initially unconjugated. Liver conjugates

• hemolysis: excess overwhelms liver, increased unconjugated

Urine

• dipstick changes color in both hemoglobin/myoglobin

• no RBC + Hgb: either hemolysis or rhabdomyolysis

B19

• school age children

• chronic hemolysis pts: chronically increased RBC turnover, depend on bone marrow tin make RBC

• B19: severe hemolysis/anemia

• low corrected reticulocyte count: not a problem with hemolysis but production

• smooth muscle spasm from low levels of NO