Hemolytic crisis: description, causes, symptoms and features of treatment

The hemolytic crisis is an acute condition,which accompanies various diseases of blood, blood transfusions, effects of poisons or the intake of medicinal substances. In addition, it is observed in infants in the first three days after birth, when the parent erythrocytes are destroyed, and in their place come the own cells of the child.

Definition

Hemolytic crisis occurs as a result ofextensive hemolysis of red blood cells. In Latin, "hemolysis" means the breakdown or destruction of blood. In medicine, there are several variants of this state:

1. Intra-apparatus, when cell damage occurs due to the connection of AIC (an artificial circulation device) during surgery or during perfusion.
2. Intracellular or physiological, when the destruction of erythrocytes occurs in the spleen.
3. Intravascular - if blood cells die in the vascular bed.
4. Post-hepatitis - the body produces antibodies that affect erythrocytes and destroy them.

Causes

Hemolytic crisis - Not an independent disease, but a syndrome,which occurs under the influence of various trigger factors. So, for example, its development can provoke the venom of snakes or insects, but it's more casuistic cases. The most common causes of hemolysis are:

• pathology of the enzyme system (this leads to spontaneous cell destruction due to their instability);
• the presence of autoimmune disease (when the body destroys itself);
• bacterial infections, if the causative agent secretes hemolysin (eg, streptococcus);
• congenital defects of hemoglobin;
• reaction to taking medicines;
• wrong technique of blood transfusion.

Pathogenesis

Unfortunately or fortunately, but humanthe body is used to respond quite stereotypically to various stimuli. In some cases this allows us to survive, but most of us do not need such tough measures.

The hemolytic crisis begins with the disturbance of the stability of the erythrocyte membrane. This can happen in several ways:

• in the form of a violation of the movement of electrolytes;
• destruction of membrane proteins by bacterial toxins or poison;
• in the form of point lesions from the effects of immunoglobulins ("perforation" of the erythrocyte).

If the stability of the cell membrane is broken,then plasma begins to actively enter into it from the vessel. This leads to an increase in pressure and eventually to cell rupture. Another option: inside the erythrocyte, oxidation takes place and oxygen radicals accumulate, which also increase internal pressure. After reaching the critical value, an explosion follows. When this happens with a single cell or even with a dozen it is imperceptible to the body, and sometimes even useful. But in the event that millions of red blood cells undergo hemolysis simultaneously, the consequences can be catastrophic.

Because of the destruction of red blood cells abruptlyincreases the amount of free bilirubin - a toxic substance that poisons the human liver and kidneys. In addition, the level of hemoglobin falls. That is, the respiratory chain is broken, and the body suffers from oxygen starvation. All this causes a characteristic clinical picture.

Symptoms

Symptoms of haemolytic crisis can be confused withpoisoning or renal colic. It all starts with chills, nausea and the urge to vomit. Then pain in the abdomen and lower back joins, the temperature rises, heart palpitations become more frequent, there is a strong dyspnea.

In severe cases, there may be a sharp drop in pressure, acute renal failure and collapse. In prolonged cases, there is an increase in the liver and spleen.

In addition, due to the release of a large amount of bilirubin, the skin and mucous membranes become yellow, and the color of urine and feces changes to a more intense (dark brown) color.

Diagnostics

The hemolytic crisis clinic itself should cause concern for a person and encourage him to go to the doctor. Especially if the following symptoms are seen:

• decrease or absence of urine;
• pathological fatigue, pallor, or icterus;
• change of color of bowel movements.

The doctor must carefully ask the patient aboutthe timing of the detection of symptoms, the sequence of their appearance and about what the patient has experienced in the past. In addition, the following laboratory tests are assigned:

• biochemical blood test for bilirubin and its fractions;
• a clinical blood test to detect anemia;
• The Coombs test for the detection of antibodies to erythrocytes;
• instrumental examination of the abdominal cavity;
• coagulogram.

All this helps to understand what exactly happens inand how to stop this process. But if the patient's condition is serious, then along with diagnostic manipulations, emergency therapy is also carried out.

Urgent care

Kupirovanie hemolytic crisis in the severe condition of the patient consists of several stages.

The first medical help is thata person is given complete peace, warms him, gives warm sweet water or tea. If there are signs of cardiovascular failure, the patient is prescribed the administration of epinephrine, dopamine and inhalation of oxygen. In severe pain in the back or abdomen, intravenously, analgesics and narcotic substances must be given. In the case of an autoimmune cause of the condition, it is mandatory to administer large doses of glucocorticosteroids.

As soon as the patient enters the hospital, urgent actions of a different level unfold:

1. If possible, the cause of hemolysis is eliminated.
2. Urgent detoxification with plasma-substituting solutions is carried out. In addition, the introduction of fluid helps to keep pressure and diuresis normal.
3. Begin a replacement blood transfusion.
4. If necessary, use gravitational surgery.

Treatment

Treatment of hemolytic crisis is not limitedlisted above. Therapy with steroids lasts from a month to 6 weeks with a gradual decrease in dose. In parallel, immunoglobulins are used that help to eliminate the autoimmune factor.

To reduce the toxic effect on the liver andkidneys use drugs that bind bilirubin. And the anemia formed as a result of hemolysis is stopped by iron preparations or by transfusion of erythrocyte mass. As prevention, antibiotics, vitamins and antioxidants are prescribed.