The destruction of the membrane of red blood cells and the removal of hemoglobin into plasma is called hemolysis. This process is due to the action of the special substance haemolysin (hemolysin). Red blood cell membranes may begin to break down due to bacterial toxins or produced antibodies. Currently, doctors distinguish several varieties of this process. They are classified depending on the method of education, on the place in which it passes, on the reasons that can cause it.
Knowing that hemolysis is the destruction of red blood cells, in which hemoglobin is released from them, many do not understand why this can happen.
Factors that lead to the destruction of the membranes of red blood cells
To understand the process itself, it is necessary to find out why the destruction of red blood cells can begin. Depending on the mechanism of occurrence, the following types of hemolysis are distinguished.
1. Natural. This process takes place constantly in the body, it begins at the end of the normal life cycle of each of the red blood cells that live about 100-130 days.
2. Chemical. It occurs if red blood cells are exposed to substances that can dissolve membrane lipids. These include various alkalis, alcohols, esters, chloroform. For example, hemolysis will be pronounced if a person recovers with a significant dose of acetic acid.
3. Biological. The erythrocyte membrane begins to collapse due to the action of hemolytic poisons , for example, as a result of insect or snake bites. Biological hemolysis also occurs due to transfusion of incompatible blood.
4. Temperature. When blood freezes in red blood cells, ice crystals form. After thawing it, they tear the shell.
5. Mechanical. When shaking a container of blood or pumping it with an apparatus that artificially supports blood circulation, red blood cells are damaged.
6. Osmotic. If the red bodies get into an environment where the osmotic pressure is lower than in the blood, then they can burst. This property is used to diagnose anemia or liver disease.
Causes of Hemolysis
To understand what and in what cases happens with red blood cells, it is necessary to fully understand such a concept as hemolysis. This destruction of the membrane of blood cells can occur inside cells or blood vessels. Typically, these types of hemolysis are caused by various diseases. But also the shells of red blood cells can be destroyed artificially in the process of laboratory research.
If we are talking about intravascular hemolysis, then the shells of the red bodies in this case are damaged in the process of blood circulation. This occurs with the following diseases:
- hemolytic anemia, including autoimmune;
- paroxysmal nocturnal hemoglobinuria;
- paroxysmal cold agglutinin disease.
Also, intratrisovascular hemolysis may indicate poisoning with hemolytic poisons.
The destruction of red blood cells inside the cells occurs in the liver, spleen or bone marrow. It is observed with health problems such as hereditary microspherocytosis, autoimmune anemia, and thalassemia. Knowing the causes that lead to the destruction of the membranes of red blood cells, it becomes clear that hemolysis is dangerous. By the way, it is these intracellular processes that are often accompanied by an increase in the size of the spleen and liver.
Symptoms of Hemolysis
If red blood cells began to break down in excess of the norm in the human body, then you can notice them only in the acute course of the disease. The most common signs of uncontrolled destruction of red blood cells are: yellowness of the skin or their pallor, lowering pressure, rapid pulse. Signs also include fragility of nails and hair.
But quite often, many do not even suspect that they have hemolysis of blood. What is it, they can find out by chance, after passing a medical examination. But in the acute course, nausea, dizziness, fatigue, weakness, and even an increase in temperature are often observed.
Hemolysis can cause anemia, which in turn is dangerous because it can cause increased thrombosis or lead to the development of gallstone disease.
Is there a reason for panic?
There are cases when laboratory patients are forced to retake the tests due to the fact that hemolysis of red blood cells has occurred. Many begin to look for signs of dangerous diseases, toxic injuries, or simply poisoning. But in most cases there is no reason for concern, because the shells of red blood cells can be destroyed due to mechanical factors. For example, often blood cells can be damaged during the transfusion of blood into a test tube, if a needle is too thin or a nurse pushes blood quickly enough. Red blood cells beat against the walls of the tube and burst. As a result, the plasma turns pink, and it becomes simply impossible to separate it in a centrifuge.
In such cases, it is said that partial hemolysis has occurred. This is not a disease, but the result of improper blood collection, storage, transportation or processing. To conduct a reliable analysis, another portion of the blood is needed. In this case, the patient is advised to drink clean water before retaking the analysis.
Acute hemolysis
But if the reason for the breakdown of red blood cells is not a nurse’s mistake, then we are talking about quite serious problems. Most often, acute hemolysis occurs during a blood transfusion when incompatible red blood cells are found. As a result, this leads to activation of the complement system, coagulation, and humoral immunity.
It is not difficult to identify it, because in this case hemolysis is a serious problem that gives a clear clinical picture. If the patient is conscious, then he will complain of pain in the chest, lower back, abdomen, agitation, feeling of heat, tachycardia. His pressure will be low. If hemolysis began during an operation performed under general anesthesia, the signs will be bleeding of the wound, and in the presence of a urinary catheter,
urine of dark red or even black color will appear in it.
Laboratory research
To confirm the diagnosis, tests are taken. If the patient has hemolysis, then the results of a blood test will reveal thrombocytopenia, hemoglobinemia, bilirubinemia, a decrease in anticoagulant potential and fibrinolysis. In the urine of such a patient, creatine levels will be increased, hemoglobinuria, hyperkalemia, a decrease in the amount of urine up to its complete absence will be observed.
When confirming that blood cells are being destroyed uncontrollably, appropriate therapy should be prescribed.
Treatment
To stop hemolysis in modern medicine is quite within reach. If it was caused by a blood transfusion, then treatment should be aimed at stopping the infusion of hostile red blood cells. In addition, it is important to start transfusion of special solutions in a timely manner, which can prevent the development of hypovolemia, renal hypoperfusion. Plasmapheresis is also performed, which is aimed at removing free hemoglobin from the circulating blood. For this, in most cases, “Heparin” is administered intravenously with an infusomat. Helps to cope with acute hemolysis and the drug "Prednisolone". All appointments are made taking into account the patient's condition, it is also important to know how long he started hemolysis. This helps doctors determine the treatment tactics, because in some cases it is necessary to carry out emergency hemodialysis. For example, it is necessary if it has been established that the patient has
acute renal failure.Medicines as a cause of hemolysis
With the use of certain medications, red blood cells can also be destroyed. To the means that cause hemolysis of blood include several groups of drugs.
- Analgesics: Amidopyrine, Acetylsalicylic acid, Antipyrine.
- Diuretics: "Fonurit", "Diacarb."
- Nitrofurans: Furadonin, Furazolin.
- Sulfanilamides: Sulfalen, Salazosulfapyridine, Salazopyridazine, Sulfapyridazine.
- Hypoglycemic drugs: Tolbutamide, Chlorpropamide.
- Anti-TB drugs: Isoniazid, PASK.
- Anti-malarial drugs: “Quinine”, “Akrikhin”, “Primakhin”.
When using these drugs, hemolysis of red blood cells can be observed. This does not indicate any problems, it occurs as a reaction to treatment.