Intravascular Hemolysis

by Carlo Raj, MD

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    00:00 Okay, if it’s intravascular, I’ll set this up once again.

    00:04 Well, the destruction of the RBC's taking place where? In your blood vessel, which is not normal.

    00:10 And so therefore the RBC’s going to release hemoglobin.

    00:14 Stop.

    00:16 Hemoglobin is not really going to get degraded further, could it? Could a patient with intravascular have jaundice? Perhaps, okay? So, but it will be mild, but usually not.

    00:29 So here, the hemoglobin is then going to be released.

    00:32 But understand, hemoglobin has a chaperone, okay? And the name of that chaperone that you must know clinically is called Haptoglobin.

    00:41 So why is it that intravascular hemolysis, you’ll find your haptoglobin decreased? Because what you are measuring would be the free haptoglobin.

    00:52 Intravascular hemolysis, I’m going to give you an example such as paroxysmal nocturnal hemoglobinuria, whatever it may be.

    00:58 Hemoglobin’s being released.

    01:00 It will bind to haptoglobin, what’s my free haptoglobin level? Good.

    01:04 Decreased.

    01:05 Your LDH, lactate dehydrogenase, that is nonspecific.

    01:09 And so, therefore that will be elevated both in extra and intravascular type of hemolysis.

    01:14 Now, the haptoglobin complex with hemoglobin is removed by the macrophages.

    01:18 The amount of unconjugated bilirubin, the bottom statement is very important.

    01:23 The amount of unconjugated bilirubin, UCB, which is lipid-soluble is not high enough to produce the jaundice, is that clear? Could you have mild? Sure.

    01:34 But as I said, it’s not significant like you found in the previous discussion with extravascular.

    01:40 We’re laying down the law and the foundation as to how hemolytic anemias work.

    01:45 You spend time understanding this, then we can very quickly go through the details and which you need to memorize a little bit with some of the pathologies.

    01:53 But these concepts, huge, huge as you can see.

    About the Lecture

    The lecture Intravascular Hemolysis by Carlo Raj, MD is from the course Hemolytic Anemia – Red Blood Cell Pathology (RBC).

    Included Quiz Questions

    1. Urine hemoglobin
    2. Decreased Hb level
    3. Increased LDH
    4. Appearance of megaloblasts on microscopy
    5. Increased bilirubin

    Author of lecture Intravascular Hemolysis

     Carlo Raj, MD

    Carlo Raj, MD

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    Terrific and easy explanation to difficult topic!
    By Pharlin N. on 04. March 2020 for Intravascular Hemolysis

    Great lecture! Dr Raj explained the materials with simplicity! Thanks so much.