Intravascular Hemolysis

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.