Haemolysis mark

The main symptoms of hemolysis are:

- Hemoglobinuria and icterus (Aulbert 2008).

In acute hemolysis may occur:

- Tachycardia

- palpitations

- exertional dyspnea (Berger 2010).

In chronic hemolysis, there are usually hardly any symptoms. Even hemoglobin levels up to 6 - 8 mg / dl are tolerated. Otherwise there may be:

- low-grade icterus

- splenomegaly (Berger 2010)

- Palpitations during exertion (Kasper 2015)

- tendency to thrombosis

-occurrence of pigment gallstones

- General symptoms of anemia such as reduction in performance, fatigue, dizziness, dyspnea on exertion (Herold 2022).

In hemolytic crisis, an acute emergency situation, may additionally occur:

- collapse

- Icterus with hyperbilirubinemia; typical for hemolysis are a strongly elevated indirect bilirubin and a normal direct bilirubin (Herold 2022)

- rapid Hb drop

- hemoglobinuria (Herold 2022)

- chills

- fever

- pain in the back, abdomen, head (Berger 2010)

In intravascular hemolysis, in which there is a rapid release of free hemoglobin, acute back pain, hemoglobinuria with appearance of free hemoglobin in the urine, and possible onset of renal failure are often found (Kasper 2015).

Laboratory chemistry includes the typical laboratory signs of hemolysis:

- Increase in LDH

- increase in reticulocytes

- Increase in indirect bilirubin (Renz 2009)

- Increase in serum iron (Knoche 2019)

- Drop in haptoglobin (Witzens Harig 2023) Haptoglobin is decreased more rapidly in intravascular hemolysis than in extravascular (Renz 2009).

- Positive Coombs test: In autoimmune hemolysis (AIHA), a Coombs test is positive in up to 97% of cases.

There is also a change in erythrocyte morphology, which, depending on the cause of hemolysis, can manifest itself as:

- spherical form in spherocytosis

- agglutination in autoimmune hemolysis

- fragmentocytes in artificial heart valves

- Detection of Heinz inner corpuscles in glucose-6-phosphate dehydrogenase deficiency

- Detection of target cells in thalassemia

- intraerythrocytic parasites in malaria (Knoche 2019)

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7. Witzens- Harig M (2023) Hemolytic anemias - overview. Thieme via medici