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.