A hemolytic crisis is an acute condition that accompanies various blood diseases , blood transfusions, exposure to poisons, or taking medications. In addition, it is observed in infants in the first three days after birth, when maternal red blood cells are destroyed, and their own cells already come in their place.
Definition
A hemolytic crisis results from extensive hemolysis of red blood cells. Translated from Latin, "hemolysis" means the breakdown or destruction of blood. In medicine, several options for this condition are distinguished:
- Intrahardware, when cell damage occurs due to the connection of an AIK (cardiopulmonary bypass) during surgery or during perfusion.
- Intracellular or physiological, when the destruction of red blood cells occurs in the spleen.
- Intravascular - if the blood cells die in the vascular bed.
- Posthepatitis - the body produces antibodies that damage red blood cells and destroy them.
Causes
Hemolytic crisis is not an independent disease, but a syndrome that occurs under the influence of various trigger factors. So, for example, its development can provoke the poison of snakes or insects, but these are more likely casuistic cases. The most common causes of hemolysis are:
- pathology of the enzyme system (this leads to spontaneous destruction of cells due to their instability);
- the presence of an autoimmune disease (when the body destroys itself);
- bacterial infections if the pathogen secretes hemolysin (e.g., streptococcus);
- birth defects of hemoglobin;
- reaction to medication;
- wrong blood transfusion technique.
Pathogenesis
Unfortunately or fortunately, the human body is used to reacting rather stereotypically to various stimuli. In some cases, this allows us to survive, but most of these tough measures are not necessary.
The hemolytic crisis begins with the fact that the stability of the erythrocyte membrane is impaired. This can happen in several ways:
- in the form of a violation of the movement of electrolytes;
- destruction of membrane proteins by bacterial toxins or poison;
- in the form of pinpoint lesions from exposure to immunoglobulins ("perforation" of an erythrocyte).
If the stability of the membrane of the blood cell is impaired, then plasma from the vessel begins to actively enter it. This leads to an increase in pressure and eventually to rupture of the cell. Another option: oxidation processes occur inside the red blood cell and oxygen radicals accumulate, which also increase the internal pressure. After reaching a critical value, an explosion follows. When this happens with one cell or even a dozen - it is invisible to the body, and sometimes even useful. But if millions of red blood cells undergo hemolysis at the same time, the consequences can be disastrous.
Due to the destruction of red blood cells, the amount of free bilirubin, a toxic substance that poisons a person’s liver and kidneys, rises sharply. In addition, hemoglobin levels drop. That is, the respiratory chain is broken , and the body suffers from oxygen starvation. All this causes a characteristic clinical picture.
Symptoms
Symptoms of hemolytic crisis can be confused with poisoning or renal colic. It all starts with chills, nausea, and vomiting. Then the pains in the abdomen and lower back join, the temperature rises, the heart rate quickens, and severe shortness of breath appears.
In severe cases, a sharp drop in pressure, acute renal failure and collapse are possible. In protracted cases, an increase in the liver and spleen is observed.
In addition, due to the release of a large amount of bilirubin, the skin and mucous membranes acquire a yellow color, and the color of urine and feces changes to a more intense (dark brown).
Diagnostics
The hemolytic crisis clinic alone should cause anxiety in a person and encourage him to go to the doctor. Especially if the following symptoms are noticed:
- decrease or absence of urine;
- pathological fatigue, pallor, or jaundice;
- discoloration of bowel movements.
The doctor must carefully ask the patient about the time the symptoms were detected, the sequence of their appearance and what diseases the patient had in the past. In addition, the following laboratory tests are prescribed:
- biochemical blood test for bilirubin and its fractions;
- clinical blood test to detect anemia;
- Coombs test to detect antibodies to red blood cells;
- instrumental examination of the abdominal cavity;
- coagulogram.
All this helps to understand what exactly is happening in the human body and how to stop this process. But if the patient's condition is serious, then along with diagnostic procedures, emergency therapy is also carried out.
Urgent Care
The relief of hemolytic crisis in a serious condition of the patient consists of several stages.
The first medical help is that a person is given complete peace, they are warmed up, they are given warm sweet water or tea. If there are signs of cardiovascular failure, the patient is prescribed the introduction of adrenaline, dopamine and inhalation of oxygen. With severe pain in the back or abdomen, analgesics and narcotic substances are necessarily given intravenously. In the case of an autoimmune cause of the condition, the administration of large doses of glucocorticosteroids is mandatory.
As soon as the patient enters the hospital, urgent measures of a different level unfold:
- If possible, the cause of hemolysis is eliminated.
- Urgent detoxification with plasma-replacing solutions is carried out . In addition, the introduction of fluid helps to keep pressure and diuresis normal.
- Begin a replacement blood transfusion.
- If necessary, use gravitational surgery.
Treatment
The treatment of hemolytic crisis is not limited to the points listed above. Steroid therapy lasts from a month to 6 weeks with a gradual dose reduction. In parallel, immunoglobulins are used, which help eliminate the autoimmune factor.
To reduce the toxic effects on the liver and kidneys, bilirubin-binding drugs are used. And the anemia resulting from hemolysis is stopped with iron preparations or red blood cell transfusion. Antibiotics, vitamins and antioxidants are prescribed as prophylaxis.