08 Hemolysis Basics

  • 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