Hemolytic crisis is an acute condition that accompanies various blood diseases, blood transfusions, exposure to poisons or drugs. In addition, it is observed in infants in the first three days after birth, when maternal red blood cells are destroyed, and the child's own cells take their place.
Definition
Hemolytic crisis occurs as a result of extensive hemolysis of red blood cells. Translated from Latin, "hemolysis" means the breakdown or destruction of blood. In medicine, there are several variants of this condition:
- Intra-apparatus, when cell damage occurs due to the connection of a heart-lung machine (heart-lung machine) during surgery or during perfusion.
- Intracellular or physiological, when the destruction of red blood cells occurs in the spleen.
- Intravascular - if blood cells die in the vascular bed.
- Posthepatitis - the body produces antibodies that infect red blood cells and destroy them.
Reasons
Hemolytic crisis - is not an independent disease, buta syndrome that occurs under the influence of various trigger factors. So, for example, its development can provoke the poison of snakes or insects, but these are rather casuistic cases. The most common causes of hemolysis are:
- pathology of the enzyme system (this leads to spontaneous destruction of cells due to their instability);
- the presence of an autoimmune disease (when the body destroys itself);
- bacterial infections, if the pathogen secretes hemolysin (for example, streptococcus);
- congenital hemoglobin defects;
- drug reaction;
- Incorrect blood transfusion technique.
Pathogenesis
Unfortunately or fortunately, but the human body is accustomed to rather stereotypically respond to various stimuli. In some cases, this allows us to survive, but in most cases, such drastic measures are not necessary.
Hemolytic crisis begins with the fact that the stability of the erythrocyte membrane is disturbed. This can happen in several ways:
- in the form of electrolyte disturbance;
- destruction of membrane proteins by bacterial toxins or poison;
- in the form of pinpoint lesions from exposure to immunoglobulins ("perforation" of the erythrocyte).
If the stability of the blood cell membrane is broken, then plasma from the vessel begins to actively flow into it. This leads to an increase in pressure and eventually to rupture of the cell. Another option: inside the erythrocyte, oxidation processes andoxygen radicals accumulate, which also increase internal pressure. After reaching the critical value, an explosion follows. When this happens with one cell or even with a dozen, it is imperceptible to the body, and sometimes even useful. But if millions of red blood cells undergo hemolysis at the same time, the consequences can be catastrophic.
Due to the destruction of red blood cells, the amount of free bilirubin, a toxic substance that poisons the human liver and kidneys, increases dramatically. In addition, the level of hemoglobin falls. That is, the respiratory chain is disturbed, and the body suffers from oxygen starvation. All this causes a characteristic clinical picture.
Symptoms
Symptoms of a hemolytic crisis can be confused with poisoning or renal colic. It all starts with chills, nausea and the urge to vomit. Then pains in the abdomen and lower back join, the temperature rises, the heartbeat quickens, severe shortness of breath appears.
In severe cases, there may be a sharp drop in pressure, acute renal failure and collapse. In protracted cases, there is an increase in the liver and spleen.
In addition, due to the release of large amounts of bilirubin, the skin and mucous membranes turn yellow, and the color of urine and feces changes to a more intense (dark brown).
Diagnosis
The hemolytic crisis clinic itself should cause anxiety in a person and encourage him togo to the doctor. Especially if the following symptoms are noticed:
- reduced or absent urine;
- pathological fatigue, pallor or jaundice;
- changing the color of bowel movements.
The doctor must carefully ask the patient about the time of onset of symptoms, the sequence of their appearance and about what diseases the patient suffered in the past. In addition, the following lab tests are scheduled:
- biochemical blood test for bilirubin and its fractions;
- clinical blood test to detect anemia;
- Coombs test to detect antibodies to red blood cells;
- instrumental examination of the abdominal cavity;
- coagulogram.
All this helps to understand what exactly is happening in the human body and how you can stop this process. But if the patient's condition is serious, then along with diagnostic manipulations, emergency therapy is also carried out.
Emergency
The relief of a hemolytic crisis in a serious condition of the patient consists of several stages.
The first medical aid is that a person is given complete rest, warmed, given warm sweet water or tea. If there are signs of cardiovascular insufficiency, the patient is prescribed the administration of adrenaline, dopamine and inhalation of oxygen. With severe pain in the back or abdomen, analgesics and narcotic substances must be given intravenously. In the case of an autoimmune cause of the condition, the appointment of large doses of glucocorticosteroids is mandatory.
As soon as the patient entershospital, another level of emergency is unfolding:
- If possible, remove the cause of hemolysis.
- Urgent detoxification with plasma-substituting solutions. In addition, the introduction of fluid helps to keep pressure and urine output normal.
- The exchange transfusion is started.
- Use gravity surgery if needed.
Treatment
Hemolytic crisis treatment is not limited to the above items. Steroid therapy lasts from a month to 6 weeks with a gradual dose reduction. In parallel, immunoglobulins are used to help eliminate the autoimmune factor.
To reduce the toxic effects on the liver and kidneys, drugs that bind bilirubin are used. And the anemia formed as a result of hemolysis is stopped with iron preparations or a transfusion of red blood cells. Antibiotics, vitamins and antioxidants are prescribed as a preventive measure.
