Chapter 23

Introduction to Increased
Destruction of Erythrocytes

Copyright © 2012, 2007, 2002, 1995 by Saunders, an imprint of Elsevier Inc.

Chapter Overview

 Classifications
 Erythrocyte hemolysis
 Excessive extravascular hemolysis
 Excessive intravascular hemolysis
 Clinical features
 Laboratory findings
 Differential diagnosis
Classifications

 Acute versus chronic

 Intrinsic versus extrinsic
 Factor inside rbc causes destruction
 Factor out of the rbc
 Inherited versus acquired
 Hereditary vs environmental
 Intravascular versus extravascular
Erythrocyte Hemolysis
 Extravascular hemolysis
 coated with antibodies or have abnormal
shape of membrane or abnormal inclusions
 Process
 Senescence cells have markers
 End products
 Immature lyses of rbcs
 Laboratory findings
 Many spherocytes
 Heinz bodies from denatured Hgb
Extravascular Hemolysis
Normal catabolism of hemoglobin. Macrophages lyse ingested red blood cells
(RBCs) and separate hemoglobin (Hb) into globin chains and heme components. The
amino acids from the globin chains are reused. Heme is degraded to iron and
protoporphyrin. Iron is returned to the plasma to be reused. Protoporphyrin is
degraded to bilirubin.
Normal macrophage-mediated hemolysis
Erythrocyte Hemolysis

 Intravascular hemolysis
 Clinical significance
 May be caused by prosthetic heart valves
 parasites
 Laboratory findings
 Hemoglobinemia
 Hemoglobinuria
 hemosiderinuria
Intravascular Hemolysis

Iron salvage mechanisms during intravascular hemolysis. CO,

Carbon monoxide; RBC, red blood cell.
 Excessive Extravascular Hemolysis

 General mechanism
 Normal red blood cell (RBC)
destruction
 Laboratory findings
 Conjugated bilirubin
 Urobilinogen
Excessive Intravascular Hemolysis

 General mechanism
 Normal RBC destruction
 Pathological processes
 Laboratory findings
 Hemoglobinemia
 Hemoglobinuria
 Hemosiderinuria
 Methemalbuminemia
 Hemopexin-heme in plasma
 Haptoglobin/hemopexin levels
Clinical Features

 General symptoms
 Fatigue
 Dizziness
 Dyspnea
 Pallor
 Tachycardia
Continued
Clinical Features─cont’d

 Symptoms in severe anemia

 Splenomegaly
 Gallstones
 Malaise, aches, vomiting, and fever
 Oliguria
 Anuria
 Color of urine
Laboratory Findings
 Accelerated RBC destruction
 Whole blood
 Reticulocyte Count
 Hematocrit
 RBC count
 Blood smear features
 Special tests
 Endogenous carbon monoxide
 Lactate dehydrogenase
 Glycosylated hemoglobin Continued

 Chromium labeling technique

Laboratory Findings─cont’d

 Accelerated RBC destruction

 Urine
 Urobilinogen
 Hemoglobinuria
 Methemoglobinuria
 Hemosiderinuria
Laboratory Findings

 Accelerated RBC production

 Whole blood
 Reticulocyte count
 Cell counts and indices
 Blood smear evaluation
 Bone marrow
 Erythroid hyperplasia
 Myeloid:erytrhoid (M:E) ratio
 Manual Cell Counts
 Hemocytometer
 Function
 When counts exceed linearity of the instrument
 When instruments are non functional
 Dimensions
 3mm x 3mm counting area
 9 (1mm x 1mm)
 Calculations for volume correction factor
Hemocytometer
 Manual Cell Counts

 Unopette system
 Function
 Components
 Procedure
 Calculations for dilution correction factor
 Total Count = cells counted x dilution factor divided
by area (mm2) x depth (0.1)
 Manual Cell Counts
 Counting cells
 Sections to count
 White blood cells (WBCs)
 Red blood cells (RBCs)
 Top-left rule
 Acceptable variation
 WBCs
 RBCs
Which Cells to Count

https://video.search.yahoo.com/search/video?fr=yfp-t-s&p=hemacytometer+counting+youtu
be#id=2&vid=22984731f27b3607942adecbc2a5052b&action=click
WBC Count