What happens after hemolysis of red blood cells. Causes and symptoms. Treatment of destruction of red blood cells

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Today, there are many diseases that affect the human body. Some of them people can get sick several times a year (viral), others have chronic form, but there are also diseases that are acquired or selectively affect the human body.
In spite of everything, no one wants to get sick, whether it's a common cold, or more serious problems with health. Unfortunately, no one asks us, and does not warn about the appearance of this or that disease, and blood hemolysis is no exception.

On the one hand, it is a vital physiological process, but this is only when the erythrocytes, as expected, live for 120-130 days, then die a natural death. Sometimes things don't go the way we want them to and we run into yet another problem.

Hemolysis - (destruction or breakdown) resulting from this process erythrocytes (red blood cells) are destroyed blood cells), which causes hemoglobin to enter the environment. Under natural and normal conditions, the life span of a blood cell inside the vessels is 125 days, and then “death” occurs - hemolysis (blood clotting).

Types of hemolysis

1. intravascular- there is a destruction of red blood cells that are in the circulating blood. If there is a lot of free hemoglobin in the blood plasma, and an increased content of hemosiderin in the urine, then these are the main signs of intravascular hemolysis.
2. intracellular hemolysis- occurs in the spleen, bone marrow, liver, in other words, in the cells of the systems of phagocytic macrophages. This type pathological hemolysis is transmitted through heredity, and is usually accompanied by an increase in the liver and spleen.

Causes of pathological hemolysis

Symptoms of hemolysis

1. Light form the disease is characterized by such symptoms: chills, fatigue, weakness, nausea, sometimes vomiting and diarrhea occur.
2. For massive hemolysis, a characteristic feature is the latent period of the disease in initial stage, which lasts from six to eight hours. After the specified time has elapsed, headache and weakness, which tends to increase. In most cases of massive hemolysis, the patient has severe nausea and vomiting. If you do not contact a specialist in a timely manner, then the next symptoms will be pain in the right hypochondrium and staining of urine in a dark red color.
3. The next symptom of the disease is an increase in erythropenia, which occurs as a result of the breakdown of red blood cells. As a result of a blood test performed by a doctor, reticulocytosis is detected in almost 100% of cases. Reticulocytosis is a significant increase in immature erythrocytes (reticulocytes) in the circulating blood, which indicates an increase in the formation of young red blood cells in the bone marrow. After the first day, the next symptoms are an increase in temperature to 38 degrees. Then the liver increases, and its functions are disturbed, in some cases, packet failure develops. If you do not take any measures, then after 3-4 days jaundice and bilirubin in the blood will appear.
4. The breakdown products of hemoglobin clog the tubules of the kidneys, thus developing renal failure with oliguria. Oliguria is a state of the body that is characterized by a sharp slowdown in the formation of urine in it. This disturbed process in the human body is a sign of a wide range of diseases of the urinary system. The end result may be anuria - the lack of urine in the bladder, or a very small amount of it.

Very interesting and the fact that hemolysis can sometimes happen outside human body such as when taking a blood test. In such cases, the analysis will not be accurate and reliable, or will not work at all. Basically, the blame for blood clotting falls on people who work with blood in the future, after the sampling.

• insufficient amount of preservatives in the test tube;
• very fast blood sampling;
• non-sterility and insufficient purity of the test tube;
• violation of aseptic conditions during blood sampling;
• eating fatty foods before blood sampling;
• violation of the conditions of transportation or storage of blood;
• temperature neglect.

Treatment of hemolysis

Regardless of whether you suffer from pathological hemolysis or not, always be attentive to yourself and listen to the "internal signals" that your body gives you. Never ignore these "signals", because it can be not only about your health, but also about your life.

Learn more about the structure and function of red blood cells in this video:

Hemolysis of blood is a process accompanied by the destruction of erythrocytes (red blood cells) and the release of hemoglobin. Of course, this phenomenon is completely natural, since on average red blood cells live for about 110-130 days. However, in some cases, premature destruction of red blood cells can lead to various complications, and sometimes to lethal outcome.

Hemolysis of blood and its varieties

To date, it is customary to distinguish two main forms of pathological hemolysis:

• Intravascular breakdown of erythrocytes occurs directly in the cavity of the vessel and is accompanied by the release of free hemoglobin into the blood. Such a violation may be the result of some autoimmune diseases, the penetration of poisons and a number of toxins into the blood.
• Intracellular hemolysis of blood is accompanied by the destruction of erythrocytes in the tissues of various organs, in particular, the liver, spleen and bone marrow. In most cases, this is a natural mechanism for the disposal of old cells. An increased level of decay may indicate the presence of some serious diseases.

Blood hemolysis: causes

In fact, the breakdown of red cells can be the result of completely different factors, both internal and external.

• Quite often, some toxins are the cause, as well as drugs.
• There is also biological hemolysis, which is caused by the poison of insects and some other animals.
• As already mentioned, pathology can occur against the background of some serious illnesses body, including autoimmune diseases, in which the immune system attacks its own
• Transfusion of inappropriate blood can also cause the destruction of red blood cells.
• Risk factors include temperature fluctuations, exposure to ultrasound.

In any case, the cause is extremely important, since the choice of treatment method depends on it.

Blood hemolysis and its symptoms

In fact, pathological hemolysis is extremely dangerous state. Its symptoms directly depend on the rate and degree of destruction of red blood cells. And do not forget that it is red blood cells that are responsible for gas exchange between tissues - with a decrease in their number,

Often, against the background of hemolysis, a special, rapidly progressive form of anemia develops. With such a disease, patients complain of a decrease in working capacity, constant weakness, dizziness, drowsiness, loss of appetite. If the destruction of red blood cells occurs inside the organs, then the disease is accompanied by an increase in the liver and spleen, periodic severe cases you can observe the development of jaundice - the skin and sclera of the eyes acquire a characteristic yellowish tint.

Blood hemolysis: treatment

As already mentioned, therapy directly depends on the form and causes of hemolysis. For example, in case of poisoning, it is necessary to remove the toxin from the body. The defeat of the poison of an animal requires the introduction of an antidote. In some cases, a blood transfusion is performed, but only from the most suitable donor. Of course, the patient is given bed rest and Sometimes surgery is done to remove the spleen.

Physiological hemolysis is also distinguished.

Life and death of a red blood cell

Hemolysis of erythrocytes constantly occurs in the body of living beings. Normally, red blood cells live for about 120 days. When destroyed, the erythrocyte membrane breaks and hemoglobin comes out. This process under physiological conditions occurs in the spleen with the help of cells of the immune system of macrophages. This is the so-called intracellular hemolysis.

If the death of an erythrocyte occurs in the vascular bed, this is intravascular hemolysis. Hemoglobin binds to a special protein in the plasma and is transported to the liver. After the chain complex reactions is transformed into bilirubin, excreted from the body with bile. There are many factors leading to pathological hemolysis.

What causes hemolysis in the body

The causes of hemolysis of red blood cells in the bloodstream are varied:

Hemolysis caused by these factors underlies acquired hemolytic anemia.

There are also congenital anemias, in which the life span of red blood cells is significantly reduced. This happens due to underdevelopment and increased fragility of the membrane or the presence in the body of aggressive factors against its own red blood cells. All this also leads to hemolysis, and intracellular, in the liver and spleen. In this case, there is an increase in these organs, a decrease in the content of erythrocytes.

Hemolysis in vitro

During hemolysis, the blood plasma turns scarlet after a large amount of hemoglobin is released into it. This blood is called "lacquer"

Hemolysis of red blood cells can happen outside the human body when a blood test is taken. As a result, the analysis will be unreliable or will not work at all. As a reason for this, there may be a violation of the technique of blood sampling, a contaminated test tube, improper storage of the taken blood, repeated freezing and thawing of blood. Even strong shaking of the test tube can cause hemolysis in the blood. As a result, the analysis will have to be taken again, which is especially undesirable in children. Therefore, it is important to comply with all rules for the collection and storage of blood by medical personnel.

Main symptoms

With a mild form, symptoms such as weakness, nausea, chills are disturbing. There may be icterus of the sclera.

With massive hemolysis, a latent period is characteristic, up to eight hours from the onset of the disease. Further weakness and a headache accrue. Possible vomiting. Disturbed by pain in the right hypochondrium, epigastrium, lower back. Often the debut symptom is hemoglobinuria, in which the urine turns dark red.

Later, due to the breakdown of erythrocytes, erythropenia increases. In the blood - pronounced reticulocytosis. The temperature rises by degrees. Next, there is an increase in the liver with a violation of its functions, up to the development liver failure. After a few days, jaundice appears. Increases bilirubin in the blood.

Due to blockage of the tubules of the kidneys by the breakdown products of hemoglobin, renal failure develops with oliguria, up to anuria.

Main laboratory signs hemolysis - hemoglobinemia, hemoglobinuria and bilirubinemia.

A sign of bilirubinemia is icterus of the sclera and jaundice

Treatment

The principles of treatment of acute hemolysis of erythrocytes, regardless of the factor that caused it, are similar. First of all, stop the intake of a factor that affects erythrocytes. Accelerate its excretion (forced diuresis, cleansing enemas, gastric lavage, hemosorption and hemodialysis). Intensive care for life-threatening complications. Symptomatic therapy. Treatment of hepatic and renal insufficiency.

With regards to the treatment of hereditary hemolytic anemias, they are difficult to treat. In some cases, with frequent hemolytic crises, the spleen is removed. At certain types anemia successfully applied hormone therapy. Well, in general, blood transfusion therapy, treatment and prevention of complications, stimulation of erythropoiesis are indicated.

Acute hemolysis of erythrocytes - serious illness requiring immediate start intensive care, since complications are fatal to the body.

Congenital hemolytic anemias require constant monitoring and treatment under the supervision of medical personnel.

When taking a blood test, it filled the test tube very slowly, practically did not flow. Sent for re-examination - the diagnosis of hemolysis? What to do?

Why does erythrocyte hemolysis occur and why is it dangerous?

A great danger to any person is the hemolysis of erythrocytes. This state characterized by the destruction of red blood cells and the release of hemoglobin. Against the background of all this, a laboratory study reveals hyperhemoglobinemia. Normal hemoglobin is healthy person is found in erythrocytes. It is a complex protein whose main function is to deliver oxygen to cells. The number of red blood cells in the bloodstream is constant. With massive hemolysis, their number decreases, which causes anemia. At the same time, the total content of hemoglobin in the vessels does not decrease. Hemolysis is not an independent disease. This process underlies many infectious diseases, hemolytic anemia, hemolytic disease of newborns.

What are the causes of its occurrence and how to deal with this pathological condition?

Features of hemolysis

The breakdown of blood cells is physiological and pathological. The lifespan of red blood cells is up to 120 days. Pathological hemolysis occurs due to exposure to internal and external factors. There are 2 main types of hemolysis: intracellular and extracellular. The first occurs in the cells of the liver, bone marrow, and spleen. Often this condition is accompanied by hepatosplenomegaly. The extracellular type of destruction of red blood cells occurs in the blood vessels.

This form of hemolysis is the basis for the development of hemolytic anemia. Depending on the mechanism of development, the following forms of hemolysis are distinguished:

• osmotic;
• biological;
• temperature;
• mechanical;
• natural.

Osmotic and temperature types are observed in laboratory conditions. This occurs due to the difference in osmotic pressure when red blood cells enter a hypotonic environment. Biological hemolysis is very common in medical practice. It arises from the following reasons: as a result of transfusion of incompatible blood components, with severe bacteremia or viremia and against the background of bites of various poisonous insects or animals. Many microorganisms have pathogenicity factors (toxins) that, when released into the blood, destroy red blood cells.

Etiological factors

The causes of hemolysis of erythrocytes in the blood are different. The most common provoking factors are the following:

• arsenic poisoning;
• salts entering the bloodstream heavy metals(cadmium, mercury);
• acetic acid poisoning;
• DIC;
• the presence of acute infectious diseases (malaria, mononucleosis);
• thermal and chemical burns;
• acute blood poisoning (sepsis);
• transfusion of incompatible blood group and Rh factor.

In some cases, the cause of this pathology can be a genetic inferiority of red blood cells. Against this background, the latter are prone to destruction. Often, the development of hemolysis of erythrocytes is observed in autoimmune disorders. In this case, their own antibodies become aggressive towards blood cells. The following diseases can contribute to this: systemic lupus erythematosus, acute leukemia, myeloma. Signs of destruction of red blood cells may appear after the introduction of a vaccine or any drug.

Clinical manifestations

An experienced doctor should know not only the causes of hemolysis, but also its symptoms. Signs of destruction of erythrocytes do not always occur. Most often, this condition is asymptomatic. Changes are detected only in the process of laboratory research. Symptoms can be found in acute hemolysis of the blood. The latter is developing very quickly. In this case, the following clinical symptoms are revealed:

In the case of a severe hemolytic crisis, convulsions and depression of consciousness may occur. In acute hemolysis, an anemic syndrome always occurs. It includes the following symptoms: weakness, malaise, pale skin, shortness of breath. Objective signs include listening to systolic murmur in the region of the apex of the heart. With intracellular acute pathological hemolysis, the liver or spleen is often enlarged. With intravascular destruction of red blood cells, the color of urine may change. In the stage of subcompensation, the symptoms decrease. Anemic syndrome is absent or weakly expressed.

Hemolytic anemia

In most cases, the pathological breakdown of red blood cells leads to the development of hemolytic anemia. This condition is characterized by accelerated destruction of red blood cells and subsequent release of the indirect fraction of bilirubin. With anemia, red blood cells live less than usual. In addition, the time of their decay is reduced. Hemolytic anemias are congenital and acquired. In the first case, the main triggering factors are: abnormalities of the membranes of red blood cells, deficiency of various enzymes, violation of the composition of hemoglobin. Secondary (acquired) anemia is most often the result of exposure to antibodies, poisons, toxins.

All hemolytic anemias are accompanied by the following syndromes: anemic syndrome, jaundice and hepatosplenomegaly. Acquired anemia may be accompanied by the following symptoms:

• pain in the epigastric region;
• high temperature;
• weakness;
• dizziness;
• yellowing of the skin;
• joint pain;
• feeling of heartbeat;
• shortness of breath.

Toxic forms of anemia are often accompanied by damage to the liver and kidneys. At autoimmune anemia patients may have hypersensitivity to the cold.

Hemolysis in newborns

Often, the destruction of red blood cells occurs in the fetus during fetal development.

This occurs in the case of a Rh conflict between the blood of the mother and the baby. In this situation, maternal antibodies penetrate the placental barrier into the baby's blood. The risk of this condition is high percentage lethal outcome. It occurs in approximately 3.5% of children. Most often, this phenomenon occurs during the second or third pregnancy. Blood incompatibility is based on the Rh factor or on the AB0 system. In the first case, for the development of hemolytic disease, it is required that the mother has a positive Rh factor, and the baby is negative.

In case of incompatibility by blood group, the mother should have group I, and the baby - any other. Most often, there are no symptoms of hemolytic disease. The fetus may experience various changes in the body. There are edematous, icteric and anemic variants of the course of hemolytic disease. In the first case, the liver and spleen increase in size, ascites occurs, and edema appears on the body. Often there are signs of pleurisy and pericarditis. In this situation, the death of the baby before or after childbirth is possible. The icteric form of hemolytic disease often causes urgent delivery. Jaundice occurs after birth. The anemic form of this pathology proceeds most easily for the fetus.

Diagnosis and treatment of hemolysis

The main method for detecting hemolysis is laboratory. When analyzing a blood sample, the following signs will indicate the development of intracellular hemolysis: an increase in stercobilin, unconjugated bilirubin, and urobilin. Signs of intravascular destruction of red blood cells will be hemoglobinemia, the presence of hemoglobin in the urine, hemosiderinuria. In acute hemolysis, treatment includes transfusion of red blood cells, the use of glucocorticoids (with an autoimmune type of hemolysis). In case of inefficiency conservative therapy the spleen is removed.

Equally important is the correction of hemodynamic disorders. For the prevention of renal failure, sodium bicarbonate and Diakarb are used. For hemolytic disease of the fetus, treatment involves accelerated elimination antibodies from the body indirect bilirubin. For this purpose, light therapy is organized. The erythrocyte mass is also introduced. In severe cases, an exchange transfusion is organized. Thus, pathological hemolysis poses a potential threat to humans. This condition requires immediate medical attention and monitoring of the patient for the entire period of treatment.

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What is hemolysis and why does it occur

The phenomenon associated with the destruction of red blood cells and the release of hemoglobin into the plasma is hemolysis. There are several classifications of this process, depending on the reasons that cause it, the place of origin, etc.

The concept of hemolysis and classification

Not everyone knows what it is and whether it poses a danger. The process takes place in the body after the erythrocytes have served their term - 4-5 months. At the end of this, the cells die.

The danger is the destruction of red blood cells at a rapid pace, as there is a risk of developing pathologies.

• physiological (biological, natural) process - the death of erythrocytes that have served their cycle;
• pathological, independent of physiology in the body.

In the first case, cells that have served their time are replaced by new ones, and the process is divided into:

• intracellular, occurring in organs (liver, bone marrow, spleen);
• intravascular hemolysis, when plasma protein transfers hemoglobin to liver cells, turning it into bilirubin, and red blood cells are destroyed directly in the bloodstream.

Pathological destruction - the death of viable red blood cells under any influence. The process is classified according to the impact factors:

• chemical - destruction of the lipid-protein shell due to the influence of aggressive products such as chloroform, alcohol, ether, acetic acid, alcohol;
• mechanical, occurring due to the destruction of the membrane shell, for example, if you shake the test tube with a sample sharply, use a heart-lung machine (hemodialysis) for blood transfusion;
• thermal when too low or heat causes the death of the erythrocyte membrane (burns, frostbite);
• biological is possible due to the penetration of toxic products into the plasma (bee, snake, insect sting), or transfusion of blood that is incompatible in the group;
• osmotic hemolysis, when red blood cells die when they enter an environment in which the osmotic pressure is less than in plasma ( intravenous administration saline, the concentration of which is below 0.85-0.9%).

Electric hemolysis is also distinguished - the death of red blood cells due to exposure to electric current.

Causes of the phenomenon

The breakdown of red blood cells in the blood serum occurs for several reasons. In acute hemolysis, an accelerated course of the reaction and a significant deterioration in the human condition are noted.

The main reasons contributing to this:

• transfusion of blood that is not suitable for the components of the patient, which is possible due to the lack of samples, as a result of a laboratory assistant's error;
• acute infection or toxic effects on the body, leading to severe hemolytic anemia and having an autoimmune character;
• isoimmune hemolytic anemia (a problem of newborns), with which the baby is born, due to the Rhesus conflict with maternal blood.

The appearance of pathological hemolysis is caused by:

Sickle anemia can cause blood damage, uncontrolled treatment medications. Some analgesics, sulfonamides, diuretics, drugs for the treatment of tuberculosis can provoke an increased death of red blood cells.

Hemolysis is possible due to violations during the test, which makes them unsuitable for further research. This happens as a result of too rapid blood sampling, non-compliance with sterility, improper storage and transportation, which causes the destruction of the membranes.

The unpreparedness of the patient for analysis also has a negative effect, for example, eating too fatty food the day before, since the decomposition of fats stimulates the development of hemolysis.

Hemolysis in children

It is detected immediately at birth, and its cause is the incompatibility of the antibodies of the mother and child. In children, severe edema, anemia, and jaundice are pronounced. As in adults, pathology is divided into intravascular and intracellular.

The incompatibility of the blood of the fetus and mother is determined during pregnancy and is often carried out intrauterine treatment. Most often, a baby is born by the method caesarean section. Hemolytic disease usually occurs in premature babies.

Further treatment of the child, and sometimes the mother, is carried out on the basis of clinical picture. It includes blood transfusion, hormone therapy.

Simultaneously with blood transfusion, glucocorticosteroid treatment is carried out, for example, with Cortisone, administered intramuscularly.

Often you have to refuse to feed the baby breast milk, which refers to non-drug methods treatment.

Symptoms and manifestations

For a healthy person, the biological hemolysis of red blood cells goes unnoticed. Clinical symptoms are possible with acute or pathological manifestations.

Signs of acute hemolysis:

• low blood pressure;
• pallor of the face, followed by cyanosis.

If the patient is conscious, there may be complaints about:

• strong pressure in the chest;
• heat in the body;
• nausea accompanied by vomiting;
• pain expressed in the lumbar region, which is typical features hemolysis.

There are no clear symptoms indicating that red blood cells are disintegrating in people undergoing hormone therapy, a course of radiation under anesthesia, or their manifestation is insignificant.

At laboratory analysis The taken samples clearly show that there is a breakdown of erythrocytes, the reaction of the blood shows that anemia is increasing, platelets are decreasing, bilirubin is increasing, and clotting is disturbed.

The color of urine also changes, it becomes dark red, biochemical analysis shows the presence of hemoglobin, potassium, protein.

Norms and detection of pathology

To determine hemolysis, the level of hemoglobin, the number of reticulocytes, and bilirubin in serum are measured. Rarely, it is necessary to measure the life cycle of erythrocytes using radioisotope methods.

To determine whether the breakdown of erythrocytes is normal, it is necessary to determine the density of their shell by the method of osmotic resistance, which makes it possible to identify the minimum or maximum destruction.

After blood sampling, a special test is carried out - the hemolysis index (HI), which allows to determine the hemoglobin content in the blood. In men, the optimal content of erythrocytes is 4.3-5.7 * 106 / μl, in women - 3.9-5.3 * 106 / μl. The number of red blood cells in a child not older than 12 years old is 3.6-4.9 * 1012 / l, 12–15 years old - 3.9-5.5 * 1012 / l.

Also, in laboratory studies, the hematocrit rate is determined as the ratio of the total volume of erythrocytes to the total volume of plasma.

The optimal value for men and women is 0.4-0.52 and 0.37-0.49, respectively.

The norm of hematocrit in children of the first day of life up to a month is from 0.56 to 0.45, from a year to 15 years - 0.35-0.39, over 15 years - 0.47.

Of no small importance is the determination of the sphericity of erythrocytes. This is the ratio between diameter and wall thickness. Normally, the value in humans is 0.26-0.28.

Erythrocytes that have served their time are spherical in shape. If such a configuration is observed in young cells, then their life span is reduced by 10 times, and they die without fulfilling their function.

The appearance of spherical blood cells allows us to draw conclusions about the increase in the sphericity index, which indicates the development of hemolytic anemia.

The most viable are young cells (reticulocytes) that have just emerged from the bone marrow. Due to their thickened disc shape, they have a low sphericity index.

If the analysis revealed an increased breakdown of erythrocytes, then a second blood donation is prescribed to eliminate errors during sampling and to verify the reliability of the result.

Therapy, consequences and prevention

Acute hemolysis requires emergency health care. Relief of the manifestations of the crisis is possible only in stationary conditions, in the intensive care unit.

The main methods of treatment include:

1. Eliminate the cause.
2. Removal of damaging elements - gastric lavage and cleansing with an enema of the intestine.
3. In the presence of renal or hepatic insufficiency, with existing comorbidities carry out symptomatic therapy, hemodialysis with the growth of urea.
4. For complicated conditions, threatening life, conduct intensive care and do blood transfusions. In case of significant damage to erythrocytes, an erythrocyte mass is administered, replacing blood transfusion.
5. In the presence of congenital anemia, they stimulate the production of red blood cells.
6. Application hormonal drugs, preventing inflammation and raising pressure in the vessels.

It is not easy to treat hereditary anemia of a hemolytic nature. Sometimes it is necessary to remove the spleen, especially with extensive damage to the organ.

Often, a blood purification procedure is required by plasmapheresis using (intravenously) the drug "Heparin", which contributes to the removal of free hemoglobin.

With signs of autoimmune hemolysis, glucocorticosteroid agents are used, for example, Prednisolone. The hemolytic crisis in the deep stage is stopped with the help of Reogluman.

A preventive measure for renal failure is the combined use of Diakarb and sodium bicarbonate.

With hemolysis, the main consequence is hemolytic anemia, often accompanied by a change in the number of platelets, leukocytes, the development of blood clots in the vessels, and the occurrence of cholelithiasis.

In order to prevent, you must follow simple rules:

• you should not collect in the forest and eat unfamiliar berries and mushrooms;
• with bites of poisonous insects, spiders, snakes until the moment of rendering qualified assistance it is necessary to cauterize the affected area within 2 minutes, apply a tourniquet so that the poison does not enter the bloodstream, and, if possible, squeeze it out.

It is important not to self-medicate by choosing random drugs. Needed therapy can only be prescribed by a specialist, having done this on the basis of examinations and analyzes.

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Hemolysis

Hemolysis (synonym: hematolysis, erythrocytolysis) is the process of damage to red blood cells, in which hemoglobin is released from them into the environment. Blood or a suspension of erythrocytes turns into a clear red liquid (lacquer blood). Hemolysis can occur in the blood (intravascular hemolysis) or in the cells of the reticulohistiocytic system (intracellular hemolysis). Normally, intracellular hemolysis is observed: part of the erythrocytes is destroyed daily, mainly in the spleen, and the released hemoglobin is converted into bilirubin. With pathological hemolysis, the breakdown of erythrocytes is increased, the production of bilirubin and its excretion with bile increases, as well as the excretion of urobilin bodies with feces and urine. If a lot of hemoglobin is released and the reticulohistiocytic system cannot cope with its processing, hemoglobinemia and hemoglobinuria occur. The breakdown of red blood cells in the blood stream takes place in two stages: chromolysis - the release of hemoglobin and stromolysis - the destruction of the stroma. Anemia is a direct consequence of hemolysis.

Hemolysis is the destruction of the erythrocyte membrane, accompanied by the release of hemoglobin into the blood plasma, which turns red and becomes transparent ("lacquer blood"). The stroma of destroyed erythrocytes deprived of hemoglobin forms the so-called "shadows of erythrocytes".

The destruction of red blood cells can occur in the body and outside it - in vitro - depending on a number of reasons. If the erythrocytes are in a hypotonic solution, then the osmotic pressure inside them is higher than in the surrounding solution, and water from the solution enters the erythrocytes, causing an increase in their volume and rupture of the membrane. This so-called osmotic hemolysis occurs when the osmotic pressure of the solution surrounding the erythrocytes is halved compared to normal. For mild hypotension saline solution, in which erythrocytes are located, they are not destroyed, but only swell and increase somewhat in size.

The concentration of NaCl in the solution surrounding the cell, at which hemolysis begins, is a measure of the so-called osmotic stability (resistance) of erythrocytes. In humans, hemolysis begins in a 0.4% NaCl solution, and in a 0.34% solution, all red blood cells are destroyed. With various pathological conditions the osmotic resistance of erythrocytes can be reduced and complete hemolysis can also occur at high concentrations of NaCl in solution.

Hemolysis can also occur under the influence of certain chemical compounds. So, it is caused by lipoid solvents - ether, chloroform, benzene, alcohol, which destroy (at their high concentration) the erythrocyte membrane. Hemolysis is also caused bile acids, saponin, pyrogallol and some other substances.

The destruction of erythrocytes can occur outside the body under the influence of strong mechanical influences, for example, as a result of shaking a blood ampule. Hemolysis is also caused by repeated freezing and thawing of the blood.

Hemolysis can occur in the body under the influence of the venom of some snakes, as well as under the action of special substances - hemolysins, formed in plasma as a result of repeated injections of erythrocytes of other animals into the blood of an animal. Hemolysins are species specific; they act on the erythrocytes only of the species of animal whose blood was injected into the body. Thus, the blood serum of a normal rabbit weakly hemolyzes ram erythrocytes. After several injections of ram erythrocytes into the blood of a rabbit, the blood serum of a rabbit, when diluted, even hemolyzes these erythrocytes tenfold.

Everything you need to know about erythrocyte hemolysis

Hemolysis of erythrocytes, or destruction, occurs constantly in the body, and completes their life cycle, which lasts 4 months. The process by which this happens as planned remains unnoticed by a person. But if the destruction of oxygen carriers is carried out under the influence of external or internal factors, hemolysis becomes hazardous to health. To prevent it, it is important to observe preventive measures, and for successful treatment- quickly recognize characteristic symptoms and find out the reasons why pathology develops.

What is this state?

The process occurs under the action of a substance - hemolysin, in the form of an antibody or bacterial toxin. Red blood cells survive destruction in the following ways:

1. Under the influence of the stimulus, the erythrocyte grows in size.
2. The cell wall is unable to expand this opportunity she does not belong.
3. Rupture of the erythrocyte membrane, in which its contents enter the blood plasma.

The video shows the process clearly.

Features and shapes

Hemolysis of erythrocytes occurs against the background of impaired production of hemoglobin, an excess of erythromycin blood cells, physiological jaundice, genetic inferiority of erythrocytes, in which they are prone to destruction, as well as autoimmune disorders, when antibodies show aggression to their own blood cells. This happens when acute leukemia, myeloma and systemic lupus erythematosus.

Similar signs appear after the introduction of certain drugs and vaccines.

Based on the site of breakdown of red blood cells, hemolysis is:

1. Intravascular, in which destruction occurs during blood circulation, and is observed in autoimmune and hemolytic. anemia, after intoxication with hemolytic poisons and in some diseases.
2. Intracellular. Occurs in the cells of macrophages in the hematopoietic organ (spleen, liver, bone marrow), and also acts as a consequence of thalassemia, hereditary macrospherocytosis, autoimmune varieties of anemia. The liver and spleen are enlarged.

Hemolysis can be caused artificially in laboratory experiments, as well as under the influence of acids, infections, poisons, substances containing heavy chemical elements or improper blood transfusion.

Mechanism

The mechanism of hemolysis in the body is as follows:

1. Natural. normal process, which occurs continuously in the body, and is the result of the life cycle of an erythrocyte.
2. Osmotic. It develops in a hypotonic environment, and is possible in the presence of substances that have a destructive effect on the erythrocyte membrane.
3. Thermal. It manifests itself after exposure to negative temperatures on the blood, and red blood cells break up with ice crystals.
4. Biological. Occurs when the body is exposed to microbes, insects, other biological toxins, or after mixing incompatible blood.
5. Mechanical. It is observed after a significant mechanical effect on the blood, when the cell membrane of the erythrocyte is damaged.

Causes and symptoms

There are several reasons why hemolysis develops, but the following are the most common:

1. Entry into the blood of heavy metal compounds.
2. Poisoning with arsenic or acetic acid.
3. Old infectious diseases.
4. Acute sepsis.
5. DIC syndrome.
6. Burns of a chemical or thermal nature.
7. Mixing blood that is not suitable for the Rh factor.

An experienced specialist must know not only the reasons why hemolysis of erythrocytes develops, but also the characteristic signs, since in the first stages the pathology is asymptomatic, and appear only during acute stage which is developing rapidly. Clinically, this manifests itself in the following:

1. Nausea, vomiting.
2. Stomach ache.
3. Change in skin color.

In a severe form of hemolysis, convulsions appear in a person, consciousness is depressed, and anemia is always present, externally manifesting itself in the form of malaise, pallor skin and shortness of breath. An objective feature is the auscultation of a systolic murmur in the heart. Both forms of hemolysis are characterized by enlargement of the spleen and liver. Intravascular destruction of red blood cells changes the color of urine.

In the case of subcompensation, the symptoms become less, anemia is absent or insufficiently expressed.

Acute hemolysis

An acute condition that has arisen with a pronounced hemolysis is called acute hemolysis. It develops with hemolytic anemia, pathologies or transfusions of incompatible blood, under the action of poisons or certain medical preparations. It is characterized by rapidly increasing anemia, an increase in the concentration of free bilirubin, neutrophilic leukocytosis, reticulocytosis, etc. As a result, decay occurs a large number erythrocytes with the release of hemoglobin.

The crisis begins with the appearance of weakness, fever, nausea with vomiting, pain in the form of contractions in the lower back and abdomen, aggravated by shortness of breath, tachycardia, fever. Severe degree of pathology is characteristic sharp decline AD, the development of collapse and anuria.

The spleen is almost always enlarged, less often the liver.

Hemolytic anemia

Very often, hemolysis is associated with hemolytic anemia. In this state, the breakdown of red blood cells occurs at a faster rate, after which an indirect fraction of bilirubin is released. With anemia, the life of red blood cells is reduced, and the time of their destruction is reduced. This type of anemia is divided into 2 types:

1. Congenital, in which the process is triggered by an abnormality of erythrocyte membranes, a violation chemical formula hemoglobin and enzyme deficiency.
2. Acquired, which cause poisons, toxins and antibodies.

Any hemolytic anemia in the body is accompanied by hepatosplenomegaly, jaundice and anemia syndrome. Its acquired variety has the following symptoms:

1. Heat.
2. Stomach ache.
3. Dizziness.
4. Yellowness of the skin.
5. Joint pain.
6. Weakness.
7. Palpitation.

Toxic anemia is often characterized by damage internal organ(kidney, liver). In autoimmune anemia, patients experience high sensitivity to low temperature.

In newborns

Hemolysis in a newborn child manifests itself in the first hours after his birth. main reason why pathology develops is the incompatibility of the Rh factor of him and his mother. This condition is characterized by anemia, jaundice and severe edema. Doctors in such cases very often record jaundice, which can lead to death. It is caused by the release of bilirubin into the blood plasma.

After that, the child feels much worse, which is manifested in lack of appetite, weakness, cramps in the limbs. In severe jaundice, there are significant skin and subcutaneous edema, anemia, an increase in the size of the spleen and liver. The light form is characterized by a fairly easy flow without any special deviations.

Timely therapy minimizes possible complications jaundice and warns its consequence - the lag of the child in development.

Diagnostics

A doctor with suspicion of pathological hemolysis is contacted if a person has the following symptoms:

1. Decreased amount of urine.
2. Paleness of the skin, weakness and other symptoms of anemia, especially when they increase.
3. The color of the urine is brown or red (tea color).

The doctor begins the examination after the following questions:

1. When and what symptoms of hemolysis were noticed.
2. Whether the patient had a history of hemolytic anemia or G6PD deficiency.
3. Whether the person has any relatives with a history of hemoglobin abnormality.

An examination for the detection of a disease will require:

1. General and chemical analysis of blood.
2. Coombs test (determines incomplete erythrocyte antibodies to the Rh factor for the test of Rh incompatibility of the blood of the mother and fetus).
3. CT or ultrasound of the abdomen or kidneys.

The main method for diagnosing pathology is laboratory. Cellular hemolysis in the results of a blood test will be indicated elevated level bilirubin, urobilin, stercobilin. For intravascular - hemoglobin in urine samples, hemoglobinemia, hemosiderinuria.

Treatment

Treatment of hemolysis is to eliminate the cause of the disease and related unpleasant symptoms. It is possible to use immunosuppressive drugs that depress the immune system, glucocorticosteroids (with an autoimmune variety), as well as replacement therapy (transfusion of red blood cells and blood components). When hemoglobin falls to critical limits, the most effective therapy is a transfusion of red blood cells. With ineffective conservative treatment the spleen is removed.

Prevention

Vitamin therapy and physiotherapy provide additional protection, especially if work or living is associated with harmful conditions. At the slightest characteristic symptoms and the unknown reason why hemolysis occurred, it is important to bring the body back to normal as quickly as possible.

The state of pathological hemolysis is dangerous for human health and requires urgent medical assistance with observation of the patient during the entire period of treatment. Its peculiarity is that in the initial stages the disease has almost no symptoms, and in the latter it progresses too quickly. To prevent similar condition it is recommended to follow preventive measures, and when planning a pregnancy, families must consult with a specialist about the formation of the Rh factor in the child and its compatibility with the mother's blood.

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On the one hand, blood hemolysis is the reason for the failed analysis, on the other hand, it is the main pathogenetic symptom of hemolytic anemias that require diagnosis and treatment. Physiological hemolysis is also distinguished.

Life and death of a red blood cell

Hemolysis of erythrocytes constantly occurs in the body of living beings. Normally, red blood cells live for about 120 days. When destroyed, the erythrocyte membrane breaks and hemoglobin comes out. This process under physiological conditions occurs in the spleen with the help of cells of the immune system of macrophages. This is the so-called intracellular hemolysis.

If the death of an erythrocyte occurs in the vascular bed, this is intravascular hemolysis. Hemoglobin binds to a special protein in the plasma and is transported to the liver. After a chain of complex reactions, it is transformed into bilirubin, which is excreted from the body with bile. There are many factors leading to pathological hemolysis.

What causes hemolysis in the body

The causes of hemolysis of red blood cells in the bloodstream are varied:

Hemolysis caused by these factors underlies acquired hemolytic anemia.

There are also congenital anemias, in which the life span of red blood cells is significantly reduced. This happens due to underdevelopment and increased fragility of the membrane or the presence in the body of aggressive factors against its own red blood cells. All this also leads to hemolysis, and intracellular, in the liver and spleen. In this case, there is an increase in these organs, a decrease in the content of erythrocytes.

Hemolysis in vitro

With hemolysis, it turns scarlet, after the release of a large amount of hemoglobin into it. This blood is called "lacquer"

Hemolysis of red blood cells can happen outside the human body when a blood test is taken. As a result, the analysis will be unreliable or will not work at all. As a reason for this, there may be a violation of the technique of blood sampling, a contaminated test tube, improper storage of the taken blood, repeated freezing and thawing of blood. Even strong shaking of the test tube can cause hemolysis in the blood. As a result, the analysis will have to be taken again, which is especially undesirable in children. Therefore, it is important to comply with all rules for the collection and storage of blood by medical personnel.

Main symptoms

With a mild form, symptoms such as weakness, nausea, chills are disturbing. There may be icterus of the sclera.

With massive hemolysis, a latent period is characteristic, up to eight hours from the onset of the disease. Further weakness and a headache accrue. Possible vomiting. Disturbed by pain in the right hypochondrium, epigastrium, lower back. Often the debut symptom is hemoglobinuria, in which the urine turns dark red.

Later, due to the breakdown of erythrocytes, erythropenia increases. In the blood - pronounced reticulocytosis. The temperature rises to 38-39 degrees. Further, there is an increase in the liver with a violation of its functions, up to the development of liver failure. After a few days, jaundice appears. Grows.
Due to blockage of the tubules of the kidneys by the breakdown products of hemoglobin, renal failure develops with oliguria, up to anuria.

The main laboratory signs of hemolysis are hemoglobinemia, hemoglobinuria and bilirubinemia.

A sign of bilirubinemia is icterus of the sclera and jaundice

Treatment

The principles of treatment of acute hemolysis of erythrocytes, regardless of the factor that caused it, are similar. First of all, stop the intake of a factor that affects erythrocytes. Accelerate its excretion (forced diuresis, cleansing enemas, gastric lavage, hemosorption and hemodialysis). Intensive care for life-threatening complications. Symptomatic therapy. Treatment of hepatic and renal insufficiency.

With regards to the treatment of hereditary hemolytic anemias, they are difficult to treat. In some cases, with frequent hemolytic crises, the spleen is removed. For certain types of anemia, hormonal therapy is successfully used. Well, in general, blood transfusion therapy, treatment and prevention of complications, stimulation of erythropoiesis are indicated.

Acute hemolysis of erythrocytes is a serious disease that requires immediate intensive care, since complications are fatal to the body.
Congenital hemolytic anemias require constant monitoring and treatment under the supervision of medical personnel.

AT medical terminology there is such a concept - hemolysis of erythrocytes, which can be described as a physiological rupture of cell membranes with a further release of its contents to the outside.

Hemolysis occurs due to natural process aging of the erythrocyte, at which its four-month life cycle is completed. Thanks to this continuous procedure, the cellular composition of the blood is constantly updated and in healthy body this event goes unnoticed.

However, due to certain factors, premature destruction of red blood cells occurs with the release of hemoglobin into the plasma. This condition can lead to the development of hemolytic anemia with accelerated pathological decay of red blood cells. Critical factors, acting on erythrocytes, increase them to a size at which cell membrane the shell is torn, as it does not have the natural ability to stretch.

Red blood cells in the human body deliver oxygen from the lungs to tissues and organs, and also move carbon dioxide in the opposite direction. In a situation of proper functioning of all body systems, the processes of formation of red blood cells and their destruction are in constant balance. If the balance is disturbed, there is an increase in the destruction of red blood cells, which can lead to acute pathological conditions.

Hemolysis can have intravascular localization - with the breakdown of red blood cells inside the vessel due to autoimmune diseases and poisoning, as well as intracellular - when the destruction of red blood cells occurs in various organs.

Hemolysis of blood is also customarily distinguished by the mechanism of its development.

Causes of blood hemolysis

Hemolysis in blood serum often occurs as a result of a violation of technology during blood sampling, which makes the sample unsuitable for further research. The reasons for the development of hemolysis during the test include:

1. Intensive blood sampling. When creating an excessively strong vacuum in the syringe, there will be an instant destruction of the erythrocyte membranes.
2. Violation of asepsis and sterility. Hemolysis can develop due to the presence of foreign microorganisms in a medical test tube.
3. Consumption of excessively fatty foods before the study. The dispersion of fats this case, will stimulate hemolysis.
4. Lack or insufficient amount of preservative. Without active substance, which allows the blood to be stored, the destruction of red blood cells will occur very quickly.
5. Incorrect sample storage. Hemolysis will begin when exposed to air, if the sample is transfused from one container to another, and the erythrocyte membranes are destroyed as a result of shaking and vibration of the blood tube.
6. Violation temperature regime. Blood will have to be retaken if it is accidentally exposed to temperature changes. Erythrocytes in the sample will remain only when certain temperature laid down for the storage of blood.
7. Wrong transport. In the case of transporting blood for analysis to third-party laboratories, the tubes must be properly packaged, otherwise shaking will destroy the red blood cells and the sample will be unusable.

Often, patients are diagnosed with a condition such as weak hemolysis as a result of a blood test. If a laboratory research was carried out taking into account all the rules, and the person was not poisoned, then a slight destruction of red blood cells could be the result of taking certain medications: analgesics, diuretics, as well as drugs that reduce blood sugar.

The causes of pathological hemolysis of non-mechanical origin include:

The most severe consequence of hemolysis occurs due to an acute hemolytic transfusion reaction, when an incompatible donor biomaterial is transfused into the recipient during invasive treatment. Hemolytic shock occurs as a result of laboratory errors due to incorrect labeling or confusion of the biomaterial immediately before transfusion.

Newborn babies are amazed hemolytic disease with rhesus conflict with maternal organism. AT circulatory system In this case, the fetus receives immune Rh antibodies that react with its own Rh-positive erythrocytes.

Hemolysis processes develop in people with autoimmune diseases, in which the tissues and cells of the body are destroyed under the influence of their own immune system.

To know for sure that red blood cells go through their entire life cycles and do not die prematurely due to diseases, it is necessary to deal with the symptoms of blood hemolysis.

Signs of erythrocyte hemolysis

In the body of a healthy person, the destruction of red blood cells goes unnoticed - this is how all physiological processes are programmed. When weak hemolysis, symptoms are either not detected or expressed increased fatigue, weakness, chills and bouts of vomiting.

Otherwise, acute, progressive hemolysis of erythrocytes manifests itself, in the initial stage of which there is a latent period, and then the person's condition worsens progressively.

Signs of rapid destruction of red blood cells are:

Laboratory blood tests with the development of acute hemolysis will show:

• an increase in blood reticulocytes;
• increase in anemia;
• decrease in platelet index;
• increase in bilirubin;
• blood clotting dysfunction.

In the treatment of severe hemolysis, the patient constantly undergoes blood tests with monitoring the dynamics of treatment. The relief of signs of a hemolytic crisis is carried out strictly in a hospital with the use of replacement therapy.