Okay, if it’s intravascular,
I’ll set this up once again.
Well, the destruction of the
RBC's taking place where?
In your blood vessel,
which is not normal.
And so therefore the RBC’s
going to release hemoglobin.
Hemoglobin is not really going to
get degraded further, could it?
Could a patient with
intravascular have jaundice?
So, but it will be
mild, but usually not.
So here, the hemoglobin is
then going to be released.
hemoglobin has a chaperone, okay?
And the name of that chaperone that you
must know clinically is called Haptoglobin.
So why is it that
you’ll find your
Because what you are measuring
would be the free haptoglobin.
I’m going to give you an example such
as paroxysmal nocturnal hemoglobinuria,
whatever it may be.
Hemoglobin’s being released.
It will bind to haptoglobin,
what’s my free haptoglobin level?
Your LDH, lactate dehydrogenase,
that is nonspecific.
And so, therefore that will
be elevated both in extra
type of hemolysis.
Now, the haptoglobin complex with
hemoglobin is removed by the macrophages.
The amount of unconjugated bilirubin,
the bottom statement is very important.
The amount of unconjugated
which is lipid-soluble is not high enough
to produce the jaundice, is that clear?
Could you have mild?
But as I said,
it’s not significant like you found in the
previous discussion with extravascular.
We’re laying down the
law and the foundation
as to how hemolytic
You spend time
then we can very quickly
go through the details
and which you need to memorize a little
bit with some of the pathologies.
But these concepts, huge,
huge as you can see.