Hemolysis: Signs Causes Treatment And Prevention
Erythrocytes, or red blood cells , are one of the essential elements of blood. They assist in carrying oxygen from and to the lungs and have the form of a mildly indented, flattened disc. A healthy red blood cell lives for around four months on average. Hemolysis is the mechanism through which the body eliminates worn-out or damaged red blood cells in the spleen and other regions of the body.
Red blood cells are normally replaced fast by the body, which produces roughly two million blood cells each second. Nonetheless, if the human body has a low amount of red blood cells due to excessive hemolysis, people may develop anemic symptoms.
Hemolytic anemia comes in various forms, each of which is diagnosed by a specialist depending on the underlying source of the anemia. A variety of factors can cause hemolysis that occurs too quickly or too frequently. Hemolytic anemia can be moderate or severe, developing abruptly or slowly. Some of the indications and symptoms are weakness, heart palpitations, dizziness, pale skin, disorientation, or a liver or spleen that is bigger than usual. Untreated or poorly managed severe hemolytic anemia can lead to significant problems.
Heres a detailed preview of hemolysis. Read on to find out what hemolysis is, some of its types, some common symptoms and causes, and how you can diagnose and treat it.
What Tests Do Healthcare Providers Use To Diagnose Hemolytic Anemia
Healthcare providers typically use several blood tests to diagnose hemolytic anemia. They may also examine blood samples for genetic markers that may be signs of inherited conditions that cause hemolytic anemia. Typically, theyll do preliminary blood tests to determine if your symptoms are caused by some form of anemia. A complete blood count is one of the preliminary tests they may do. A CBC measures:
- How many red blood cells, white blood cells and platelets you have.
- The size of your red blood cells.
- Hemoglobin, the protein in your blood that carries oxygen throughout your body.
- Hematocrit, which measures the amount of space your red blood cells take in your blood.
How Does Hemolyzed Specimen Affects The Test Result
Certain lab tests can be affected and the reported results will be inaccurate. It falsely decreases values such as RBC’s, HCT, and aPTT. It can also falsely elevate potassium, ammonia, magnesium, phosphorus, AST, ALTAST, ALTThe AST/ALT ratio or De Ritis ratio is the ratio between the concentrations of the enzymes aspartate transaminase and alanine transaminase, aka alanine aminotransferase in the blood of a human or animal.https://en.wikipedia.org wiki AST ALT_ratioAST/ALT ratio – Wikipedia, LDH and PT.
What Is Hemolysis
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In The Field: Forensic Scientists Use Hemolysis Reference Palette In Crime Lab
Forensic scientists at the Scottsdale Police Department Crime Laboratory used the Hemolysis Reference Palette for hemolysis status to study the effects of blood hemolysis on forensic blood ethanol testing. They used the reference palette to qualitatively gauge the degree of hemolysis with their test samples. Learn more about this interesting application in the Journal of Forensic Sciences .
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What Happens When Blood Hemolyzed
“Hemo” means blood, of course “lysis” means to rupture or the destruction of cells. So hemolysis is literally the destruction of blood cells, specifically red blood cells. When red cells rupture, they spill their contents, mostly hemoglobin, into their surroundings.
Preventing Hemolysis In The Blood Samples You Draw
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How Do I Take Care Of Myself
Healthcare providers may be able to cure your hemolytic anemia. Once youre feeling better, you may be interested in learning how to manage your health to avoid another bout of illness. Some suggestions that may help you to manage anemia include:
- Follow a healthy diet rich in vitamins B12, C and B9 . Ask to speak to a nutritionist if youd like more information on ways to keep your red blood cells strong.
- Drink enough water to stay hydrated.
- Get regular exercise. Check with your healthcare provider about ways to exercise safely.
- Avoid infections by washing your hands and avoiding people when theyre sick.
- Keep track of your symptoms by writing them down.
- Talk to your doctor about any changing symptoms.
A note from Cleveland Clinic
Hemolytic anemia happens when something is destroying your red blood cells. This condition may be a sign you have an inherited medical condition or a medical issue caused by infection. You may be reacting to specific medications. Regardless of the cause, your healthcare provider will focus on finding and treating the underlying cause. Prompt treatment often makes the difference between getting well and getting worse. Hemolytic anemia symptoms may look and feel like less serious conditions. You know your body best, including how long it takes you to recover from everyday illnesses. Talk to your healthcare provider whenever youre concerned about changes in your body that dont go away.
Key Points About Hemolytic Anemia
- Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than they are made.
- Inherited hemolytic anemia means that parents pass the gene for the condition on to their children.
- Acquired hemolytic anemia is not something you are born with. You develop the condition later.
- Symptoms include weakness, paleness, jaundice, dark-colored urine, fever, inability to do physical activity, and heart murmur.
- Treatment includes blood transfusions, corticosteroids, and other medicines
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What Are Hemolytic Anemia Symptoms
Hemolytic symptoms can be mild or more severe. They also can come on suddenly or develop over time. Typical symptoms include:
- Jaundice: This condition affects your skin, the whites of your eyes and your mucous membranes, causing them to turn yellow. This happens when you have a high level of bilirubin caused by a breakdown of your red blood cells.
- Shortness of breath : This happens when you dont have enough red blood cells carrying oxygen throughout your body.
- Fatigue: Fatigue is a sensation of being so tired that it affects your daily life and your ability to do your daily activities.
- Fast heartbeat : This condition means your heart is beating faster than it should. When your heart beats too fast, it doesnt have enough time between beats to fill up with blood, and your heart cant supply your body with the oxygen it needs.
- Low blood pressure: Low blood pressure can be a symptom or a condition. It happens when your blood pressure is much lower than expected.
- Blood in your pee : This can be a symptom of sickle cell disease.
- Enlarged spleen or liver: Your liver and spleen filter red blood cells as the cells move through your body. Red blood cells that are damaged or dying are trapped by your spleen and liver, which destroy the cells. A larger-than-normal spleen or liver may be a sign your red blood cells are damaged.
Hellp: Diagnosis And Clinical Characteristics
HELLP has been reported to affect 0.170.85% of all live births, and occurs most commonly in a slightly older population than preeclampsia, with a mean age of 25 years.108 In 70% of cases, HELLP is diagnosed antepartum, primarily between 27 and 37 weeks of gestation 30% of cases develop postpartum.113 The percentage of nulliparous patients ranges from 52% to 81%, a lower proportion than those with preeclampsia.108,114 HELLP syndrome, particularly when it develops early in pregnancy,115,116 may be associated with antiphospholipid antibodies in some patients.117,118 Patients with HELLP characteristically present with nonspecific complaints, including nausea, fatigue, and malaise. Right upper quadrant and epigastric pain is the most common symptom, occurring in 8692% of patients in occasional patients right upper quadrant pain may precede the onset of liver enzyme abnormalities.108,114 Thus, patients with HELLP may be mistakenly diagnosed with a primary gastrointestinal disorder, particularly since only 5070% of these patients have hypertension at the time of presentation the differential diagnosis in a patient with such manifestations is wide . Patients may have accompanying edema, and 515% have no or minimal proteinuria 15% may have neither hypertension nor proteinuria.106,108 Patients who present with HELLP postpartum usually do so within several days after delivery,119 with 6% of these individuals having no antepartum signs of preeclampsia.108
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How Do Healthcare Providers Treat Hemolytic Anemia
Healthcare providers treat hemolytic anemia based on the cause of your illness and if youre having severe symptoms. For example, if your healthcare provider believes you have severe anemia, they may order blood transfusions to stabilize your red blood cell count. Then theyll diagnose the underlying condition thats causing you to have anemia so they can treat the condition.
Understanding The Hemolyzed Blood Test Results
Was a blood test recently ordered for you? When the results came back, did the doctor tell you that your test had been hemolyzed? When lab reports indicate that a blood specimen has been hemolyzed, then this is an indication that the red blood cells in that sample were destroyed in some way. The destruction of the red blood cells will release hemoglobin and this renders the sample useless.
When a hemolyzed blood test is the result, most doctors will order another blood draw so that the test can be accurately completed. Not all test results are affected by hemoglobin, however, so if you did get your results back and it was noted that the blood test was hemolyzed, then there is nothing to worry about at all.
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Toxic Agent Ingestion Or Poisoning
Hemolysis may result from intrinsic defects in the red blood cell itself:
- Defects of red blood cell membrane production
- Defective red cell metabolism
- Paroxysmal nocturnal hemoglobinuria , sometimes referred to as Marchiafava-Micheli syndrome, is a rare, acquired, potentially life-threatening disease of the blood characterized by complement-induced intravascular hemolytic anemia.
How Do You Prevent A Hemolyzed Specimen
Best Practices to Prevent Hemolysis
Why is it important to avoid hemolysis?
Prevention of hemolysis is important to preserve the quality of a serum sample for testing.
How can I stop my blood from being Hemolyzed?
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The Hemolysis Index Of Your Dog Or Cats Blood Sample
Hemoglobin , the red pigment that carries oxygen, belongs in your dog or cats red blood cells . When this pigment escapes into solution during or after a blood sample is collected, the sample is said to be hemolyzed. When it escapes while still in the blood stream, a process called intravascular hemolysis has occurred.
The second cause is quite rare but both conditions when substantial can falsely alter some of your pets other blood test results. Some of those altered values can be adjusted to correct the value using mathematical formulas. But it is always wise to have a new non-hemolyzed sample from your dog or cat resubmitted. Misleading results that are possible due to a hemolyzed blood samples include elevated levels of potassium, phosphate, CK, AST, LDH, uric acid and magnesium and decreased levels of AP, amylase and GGT.
What Are The Different Types Of Hemolysis
There are two types of hemolysis. Their names indicate where hemolysis takes place.
- Extravascular hemolysis involves red blood cell destruction that takes place outside of your blood vessels. Blood vessels include veins, arteries and capillaries. Your spleen is the most common site of extravascular hemolysis. As blood filters through your spleen, white blood cells called macrophages locate old or damaged red blood cells and destroy them.
- Intravascular hemolysis involves cell destruction that happens within your blood vessels. With intravascular hemolysis, the parts of the destroyed cells circulate within your blood.
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What Infections May Cause Hemolytic Anemia
Infections linked to hemolytic anemia include:
- Malaria:This disease happens when mosquitos infected with tiny malaria parasites bite people, leaving parasites in people’s bloodstreams. Left untreated, malaria can cause hemolytic anemia.
- Rocky Mountain spotted fever: This infection spreads when ticks infected with the bacteria Rickettsia rickettsi bite people.
- Haemophilus influenza disease:These are infections caused by the bacteria H. influenza.
- Human immunodeficiency virus : This virus causes acquired immune deficiency syndrome .
Reject Or Not To Reject
There is an ongoing debate as to whether laboratories should or should not report results from samples affected by hemolysis.22,48 This issue is not easy to answer or resolve since both choices could affect the treatment or management of patients especially in acute or emergency care. In the absence of sufficient relevant and specific clinical data and guidelines, there is understandably substantial heterogeneity among the laboratories, statewide, nationwide, and globally in the way they handle and manage hemolyzed specimens.3,49 Most clinical laboratories will reject hemolyzed samples and request recollection. This practice has consequences since repeating sample collection is not always possible and rejecting the sample means subjecting patients to another invasive test and may delay diagnosis. Rejecting the sample may cause other potential harm to the patient should it lead to an incorrect clinical decision, treatment option, or patient monitoring following the lack of laboratory results.50,51 For laboratory specialist dealing with analytes measurement is another challenge.
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What Inherited Conditions Can Cause Hemolytic Anemia
Some common inherited conditions are:
- Sickle cell anemia: In this disease, your body produces abnormally shaped red blood cells that are trapped in small blood vessels, your spleen or liver.
- Thalassemia: This is another group of inherited blood disorders that cause your body to make abnormal red blood cells that are easily destroyed.
- G6PD deficiency: This genetic disorder affects an enzyme that protects red blood cells. When this enzyme level drops, blood cells exposed to certain infections or medications are likely to break apart.
Causes Of Hemolytic Anemia
Its conceivable that a medical practitioner wont be able to figure out whats causing hemolytic anemia in a patient. This disorder, however, can be caused by a variety of conditions and even some drugs. Hemolytic anemia can be caused by several things, including infectious hepatitis, enlarged spleen, typhoid fever, Epstein-Bar virus, lymphoma, E. coli toxin, leukemia, lupus, and tumors.
As mentioned above, hemolytic anemia can sometimes be caused by taking specific drugs. Drug-induced hemolytic anemia is the name for this condition. Antibiotics like penicillin, cephalexin, methicillin, rifampin, chlorpromazine, ceftriaxone, ampicillin, ibuprofen, interferon-alpha, and procainamide are some examples of drugs that may cause the illness. The type of hemolytic anemia produced by getting an RBC transfusion of the incorrect blood type is one of the most serious.
Everyone has a different blood type. If an individual is given a mismatched blood type, antibodies, which are specialized immune proteins, will assault the unwanted red blood cells. Consequently, red blood cells are destroyed exceedingly quickly, which can be fatal. This is why, before providing blood, medical professionals must thoroughly verify blood types. Hemolytic anemia can be caused by various factors, some of which are just transient. If a physician can detect and treat the root cause of hemolytic anemia, it may be cured.
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Which Situation Can Hemolyze A Specimen
Hemolysis may be due to specimen collection, processing, or transport. Hemolysis may also be due to pathological conditions, such as immune reactions, infections, medications, toxins and poisons, and therapeutic procedures. Frequently, laboratory testing can still be performed on a hemolyzed sample.
How Do I Reduce My Risk Of Developing Hemolytic Anemia
Hemolytic anemia may be caused by several factors, most of which you cant control. For example, you can develop hemolytic anemia after being injured o by inheriting certain conditions. You can, however, reduce your risk for serious illness by talking to your healthcare provider any time you develop symptoms that may be anemia.
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What Are The Options That Are Available
The most common reaction to a hemolyzed blood test result is to take another blood sample. A different location may be chosen and the technician taking the sample may try using a different needle gauge to lessen the risks of a second occurrence.
When all of the blood collection assemblies are not properly fitted and frothing occurs, there will be an increased risk of experiencing a hemolyzed blood test. A greater focus on the timing of activators and other materials used with the test will also be in place.
From the patient perspective, there is really just one thing to do: relax as best as possible. Make sure the arm isnât tense and rigid and avoid flinching when the needle is inserted.
A hemolyzed blood test does not mean there is something wrong with a patient. It just means that there was a problem involved at one point in the testing chain and this causes the membranes of the red blood cells to be destroyed. You may wish, however, to discuss with your health provider about who will be responsible for payment of the second blood draw.