08 Hemolysis Basics
- fewer red cells but same shape
- non hemolytic: underproduction of bone marrow
Reticulocytes
- left: low retic
- right: high retic
- lower Hct: retic will rise simply because more of them compared to Hct. Does not need increased production
Intravascular and Extravascular
- hemolytic disorders in which shape of RBC's abnormal: increased removal
Haptoglobin
Labs
LDH, Bilirubin
- RBC: no mitochondria, no oxidative phosphorylation, no acetyl coa step, can only make lactate via LDH
- heme released from hemolysis
- initially unconjugated. Liver conjugates
- hemolysis: excess overwhelms liver, increased unconjugated
Urine
- dipstick changes color in both hemoglobin/myoglobin
- no RBC + Hgb: either hemolysis or rhabdomyolysis
B19
- school age children
- chronic hemolysis pts: chronically increased RBC turnover, depend on bone marrow tin make RBC
- B19: severe hemolysis/anemia
- low corrected reticulocyte count: not a problem with hemolysis but production
- smooth muscle spasm from low levels of NO
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