Hemolysis

Hemolysis is also an important factor in medical tests, as a blood sample may become hemolysed with prolonged storage, or during venipuncture. This may cause interference with the test results for a patient.

Hemolytic anaemia

Normally, a red blood cell survives 90 to 120 days in circulation: about 1% of human red blood cells break down each day, which matches the production rate.

When the rate of breakdown increases, the body compensates by producing more red blood cells. If compensation is adequate there are few clinical problems.

If breakdown occurs at such a rate that it exceeds the body's ability to keep up, and then anemia develops.

Detection of hemolysis

Hemolysis can be distinguished from other forms of anemia in several ways:

• certain aspects of the medical history can suggest a cause for hemolysis (drugs, fava bean or other sensitivity, prosthetic heart valve, or other serious medical illness)
• when peripheral blood smear is examined microscopically:
  • fragments of the red blood cells ("schistocytes") can be present
  • some red blood cells may appear smaller and rounder than usual (spherocytes[?])
  • reticulocytes[?] are present in elevated numbers. This may be overlooked if a special stain is not used.
• the level of unconjugated bilirubin in the blood is elevated
• the level of lactate dehydrogenase[?] (LDH) in the blood is elevated
• haptoglobin levels are decreased
• serologic antibody testing, specifically the direct Coombs test, can be abnormal

Causes of hemolysis

• Autoimmune disease (antibodies)
• Abnormal red cells, e.g., hereditary spherocytosis[?]
• Drug + antibody (i.e., some drugs lead to haemolysis mediated by an antibody)
• G6PD deficiency[?] and other enzyme deficiencies
• Mechanical (heart valves, microvascular disease)
• Toxins (e.g., snake venom)

Ineffective hematopoiesis is sometimes misdiagnosed as hemolysis.

• Clinically these conditions may share may features of hemolysis
• Red cell breakdown occurs before a fully developed red cell is released into the circulation.
• Examples: thalassemia[?], myelodysplastic syndrome