Blood Hemolysis During Testing - What Is It?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Hemolysis - what is it?

Hemolysis is the process of completing the four-month life cycle of erythrocytes, which are destroyed naturally or by exposure to their membranes of poisons, infectious agents, antibodies, drugs.

Content:

• Where does hemolysis occur?
• The natural process of hemolysis is the norm
• Manifestation of hemolysis
• Hemolysis treatment
• Pathological hemolysis: causes and types
• Analysis for osmotic resistance of erythrocytes
• Drug therapy and hemolysis

Where does hemolysis occur?

Types of hemolysis, depending on the location:

• Intravascular hemolysis. It occurs in the circulating blood, where the environment acts on the red blood cells.
• Intracellular hemolysis. It occurs in the liver, spleen, bone marrow - organs involved in hematopoiesis or in the accumulation of blood corpuscles.

In some cases, hemolysis can occur outside the human body when the blood clot dissolves and stains the plasma under laboratory conditions.

Causes of hemolysis in blood tests:

• non-compliance with the technique of sampling biomaterial, the rules for its storage;
• deliberate provoking of the process of lysis of erythrocytes, which is necessary to obtain a population of other blood elements.

The properties of blood plasma and serum and their differences are very important for hemolysis. Fibrinogen (hereinafter fibrin) of plasma is the basis of a blood clot that descends to the bottom of the tube, converting plasma into serum. In the circulatory system, blood normally does not clot. This occurs in exceptional cases - with disseminated intravascular coagulation, when a person's life is at risk. But even there, serum is not formed, it is formed only outside the human body from fibrin filaments, which are converted into a blood clot.

A blood biochemistry test taken with an anticoagulant, or taken in a dry test tube without the use of anticoagulants, will have incorrect results due to hemolysis of erythrocytes.

The natural process of hemolysis is the norm

During natural hemolysis in a healthy body, physiological death of old erythrocytes occurs. This process takes place in the red bone marrow, in the liver and spleen.

In pathological hemolysis, erythrocytes die prematurely due to stretching and rupture of the cell membrane. The discocytes are affected by unfavorable factors, due to which hemoglobin from the membrane is released into the blood plasma.

After the release of the red pigment, the plasma takes on an unnatural appearance and becomes shiny. This sign of hemolysis is easy to see with the naked eye.

Manifestation of hemolysis

Chronic hemolysis accompanying diseases such as leukemia, sickle cell anemia, occurs without severe symptoms, like many other physiological processes.

Causes of acute hemolysis requiring urgent care:

• Blood transfusion incompatible by group and Rh factor;
• Autoimmune hemolytic anemia, or anemia caused by poisoning;
• Hemolytic disease of the newborn, when every breath of the newborn worsens the situation.

If the patient is conscious, he experiences the following symptoms:

• Feeling hot;
• Severe chest compression;
• Lower back pain, possibly chest and abdominal pain.

Other symptoms:

• A sharp decrease in blood pressure;
• Hyperemia of the facial skin, turning into cyanosis;
• Spontaneous urination and defecation;
• According to laboratory studies, intravascular hemolysis occurs in the circulatory system.

With radiation and hormone therapy, during anesthesia, the signs can be erased. After a few hours, the acute symptoms subside, leaving back pain.

After a short time, a relapse occurs with the following manifestations:

• Hyperthermia;
• Jaundice of the skin and sclera of the eyes;
• Severe headache;
• Disorder of kidney function: protein and hemoglobin in urine, cessation of urination, further anuria, uremia, death.

Coagulogram indicators:

• Anemia caused by the release of hemoglobin into the plasma after the destruction of red blood cells;
• Thrombocytopenia;
• High bilirubin levels;
• Disruption of blood coagulation processes.

The urine becomes red or black, protein, potassium, hemoglobin are found in it.

Hemolysis treatment

Therapy for hemolytic crisis depends on the severity of the patient's condition, on the causes that caused it.

Appointments:

• Replacement blood transfusion (for hemolytic disease of the newborn);
• Introduction of blood substitution solutions;
• Plasmaphoresis;
• Administration of hormones;
• Hemodialysis.

The effectiveness of the measures is monitored by constant laboratory research.

Pathological hemolysis: causes and types

Types of hemolysis and the causes that caused it:

• Immune. Caused by autoimmune diseases, hemolytic anemia, incompatibility with blood transfusion.
• Mechanical. It occurs when tissue is crushed, extensive injuries, careless handling of blood samples.
• Thermal. It is caused by freezing and heating of solutions.
• Chemical. It occurs upon contact with aggressive media that have penetrated the respiratory or digestive system as a result of injections. In the laboratory, samples can be spoiled by contact with acid or alkali.
• Electric. It occurs with electric shock, in the laboratory - when blood is placed in an electric field.
• Biological. It develops due to the effects of poisons of animal or plant origin: snake bite, contact with pale toadstool and other poisonous fungi, penetration of the malaria plasmodium into the body.
• Osmotic. It occurs due to the effect on erythrocytes of a hypotonic solution (0.48%, 0.32%) of sodium chloride, which is used to increase the volume of circulating blood and destroy red blood cells.

Analysis for osmotic resistance of erythrocytes

This blood test is aimed at determining the stability of red blood cells when placed in a hypotonic solution.

Research parameters:

• Minimum OSE - erythrocytes are destroyed in 0.45-0.48% solution of NaCl;
• Maximum OSE - destruction of erythrocytes occurs in 0.32-0.34% NaCl solution.

Indicators of osmotic resistance depend on the shape of the cells and the degree of their maturity. Normally, the ratio of thickness to diameter (sphericity index) is 0.27-0.28.

Mature erythrocytes, which are on the verge of their existence, have a spherical shape, low membrane strength. In hemolytic anemia, a large number of spheroid forms speaks of the imminent death of erythrocytes, a reduction in their life by 10 times, up to 12-14 days.

The spherical shape of red blood cells in anemia indicates an increase in the sphericity index - a symptom of premature death of red blood cells.

The most resistant to hypotension are reticulocytes recently released from the bone marrow. They have a flattened disc shape and a low level of sphericity. Osmotic resistance analysis can be an indicator of the activity of the red blood brain.

Drug therapy and hemolysis

Some drugs accelerate the destruction of erythrocytes, hemolysis is their side effect. When the drug is discontinued, this process stops.

Drugs causing hemolysis:

• Analgesics and antipyretics (Aspirin, Amidopyrin);
• Diuretics (Diacarb) and nitrofuran preparations (Furadonin);
• Sulfonamides (Sulfalene, Sulfapyridazine);
• Drugs to lower blood sugar (Tolbutamide, Chlorpropamide);
• Anti-tuberculosis drugs (isoniazid, PASK);
• Drugs for the treatment of malaria (Quinine, Akrikhin).

Problems caused by the use of drugs should be reported to the attending physician.

Video: experience - hemolysis of erythrocytes under the influence of alcohol:

The author of the article: Shutov Maxim Evgenievich | Hematologist

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016 completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.