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Hemolysis is the breakdown of red blood cells under the influence of various factors. As a result of this breakdown, hemoglobin is released from the red blood cells into the blood plasma. High intensity of haemolysis may even lead to haemolytic anemia.
Hemolysis – causes
Hemolysis can occur for many different reasons, which can be divided into congenital disorders and acquired disorders. The causes of congenital haemolysis include a defect in the structure of erythrocytes, which itself leads to their too early breakdown. Another type of birth defect is spherocytosis or ovalocytosis, i.e. defects in the erythrocyte cell membrane. Other causes of congenital haemolysis include deficiency of glucose-6-phosphate dehydrogenase or pyruvate kinase. Yet another cause of congenital haemolysis is thalassemia.
The causes of acquired haemolysis are most often immunological or autoimmune factors, such as the body’s reaction to blood transfusions. Other acquired causes of haemolysis include exposure to chemicals, bacterial infection, parasitic infection, blood disorders, nocturnal paroxysmal hemoglobinuria, and even vigorous exercise or mechanical factors such as the insertion of an artificial heart valve.
Haemolysis can also occur due to spleen disease (especially when it is enlarged, destroying red blood cells) or due to medications such as ribavirin. It is also worth knowing that there are two types of haemolysis: intra- and extravascular. It is about the place where blood cells break down: inside, ie in the vessel, outside, ie in the reticulo-epithelial system.
Symptoms of hemolysis
Breakdown of red blood cells can manifest as hyperbilirubinemia, as jaundice will appear by the release of bilirubin. The laboratory test of blood will also increase the percentage of reticulocytes when the body signals the bone marrow to produce more red blood cells, because they break down too quickly and there are too few of them. Another symptom is a drop in free haptoglobin levels.
The symptoms typical of anemia can be attributed to the visible symptoms of haemolysis, namely:
- pale skin,
- weakness,
- tachycardia,
- faster fatigue even with little physical exertion or jaundice.
Acute haemolysis can lead to a haemolytic crisis, which in turn can result in acute renal failure. Hemolysis does not always produce immediate symptoms. If its course is long-term, but of low intensity, the body itself can adapt to unfavorable conditions, so the symptoms will not appear immediately, but even after several years. In the case of acute haemolysis, the symptoms will appear very quickly.
Depending on the cause of the hemolysis, other symptoms may appear. For example, in congenital spherocytosis, the symptom will be congenital abnormal bone development and gallbladder stones. And with paroxysmal cold hemoglobinuria, it will include back pain, limb pain, abdominal pain, chills or fever appearing after exposure to cold.
Treatment of hemolysis
Treatment of haemolysis depends on the cause of its occurrence. This can be supplementation with folic acid or iron (in case of deficiencies). As a preventive measure, in paroxysmal cold hemoglobinuria, cold should be avoided, and, for example, thalassemia is additionally treated with vitamin C and zinc. If hemolysis occurs due to autoimmune reasons, treatment is based on immunosuppressive drugs.