Hemolytic jaundice: what is it?

A pathological condition of the body, which is outwardly manifested by the yellowing of the skin, mucous membranes, and eye sclera, and internally – high level of bilirubin in the blood called hemolytic jaundice. This complex of symptoms may be acquired as a result of a number of reasons, but often congenital.

Hemolytic jaundice: the mechanism of

The development of hemolytic (suprarenal) jaundice is caused by disruption of the erythrocytic system. There is a high percentage of decay of Mature or immature blood cells – erythrocytes. This process leads to increased synthesis of hepatic pigment – bilirubin. The liver can not cope with the processing and removal from the body of a large number of bilirubin through the biliary tract (in the bile), and it remains in the body, circulating in the blood.

Due to the fact that bilirubin does not fall through the liver into the biliary tract and further into the intestine, the jaundice is called suprarenal. The term «hemolytic» is due to the main mechanism of the appearance of jaundice – hemolysis, or the destruction of red blood cells with their contained hemoglobin. Causes of hemolytic jaundice:

  • Innate (genetically determined) pathology, accompanied by the breakdown of hemoglobin or of red blood cells. These include hemolytic anemia (sickle cell, mikrosferocitoz, thalassemia) with erythrocytic defect – abnormal lipids or proteins in the composition of the cell membrane.
  • Some serious infectious and septic diseases occurring with the destruction of red blood cells – malaria, protracted septic (purulent) endocarditis, croupous pneumonia, sepsis.
  • Autoimmune processes, in which the immune system mistakes RBCs for foreign elements to the body and attacks them, forming antibodies to antigens of red blood cells of your body. When this occurs, the intracellular or intravascular hemolysis.
  • Poisoning hemolytic poisons, which include lead and its compounds, aniline, hydrogen, arsenic, quinine, phenylhydrazine hydrochloride, sodium nitrite, sulphide, and some poison mushrooms, snake venom. Poisoning with subsequent hemolysis may occur in the use of excessive quantities of some medicines, such as PASK (antituberculosis drug), sulfonamides (Biseptol, Sulfadimetoksin, Sulfapiridazin, Resultan and others).
  • Other serious diseases that cause hemolytic effects: pulmonary infarction, tumours, severe hepatitis and hepatosis.
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    The symptoms of the pathologies that occur with hemolytic jaundice:

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    • the appearance of jaundice, lemon-yellow or pale lemon color, the coloration of the skin, sclera and mucous membranes;
    • noticeable darkening of urine and feces;
    • the increase in body temperature, often wavy;
    • a significant increase in the size of the spleen;
    • General weakness and fatigue, frequent dizziness.

    For hemolytic jaundice is characterized by the absence of pruritus (in contrast to other hepatic pathologies). The border of the liver often normal, sometimes there is a slight increase in liver size.

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    Diagnosis

    Identify diseases associated hemolytic jaundice, carried out with the help of some studies:

    • serological examination of blood for antibodies to the hepatitis;
    • deployed and biochemical blood tests required determining the number of reticulocytes and of all factions of bilirubin and trasfers – «liver» tests;
    • urine tests: General the presence of bile pigments;
    • Coombs ‘ test for detection of antibodies to their own red blood cells of the body;
    • ultrasound examination of the liver and biliary tract;
    • puncture of the liver and red bone marrow purpose with biopsy.

    Treatment

    Therapy is prescribed depending on the causes of hemolytic jaundice, and based on the results of the survey and the General condition of the patient. The following methods are used:

    • In the presence of autoimmune processes – the introduction of glucocorticosteroid drugs (Dexamethasone, Prednisone) and immunosuppressants (Cyclosporin And Methatrexate, Imuran).
    • Introduction to the bloodstream (transfusion) Packed red cells washed red blood cells. Such a component of blood obtained by blood centrifugation and washing with saline. The result is red blood cells without plasma, leukocytes, and platelets.
    • Plasmapheresis – a procedure of drawing blood, its purification and return to the introduction into the bloodstream.
    • Intravenous injection of saline and colloidal solutions.
    • Anemia with defects of erythrocyte membranes in the absence of effect of conservative therapy is carried out spleen removal – splenectomy.
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    Hemolytic disease of the newborn

    Hemolytic jaundice in newborns occurs because of serologic incompatibility in the RH factor or blood group of the child and the mother. Thus there is a massive breakdown of red blood cells the fetus is in the womb and then – newborn. Hemolytic jaundice develops on the first, rarely the second day after birth. Is characterized by yellowing of the skin, mucous membranes and sclera, and also the development of anemia and enlarged liver and spleen.

    Hemolytic disease of the newborn (GBN) is a formidable disease that requires around the clock monitoring and required urgent treatment. Of therapies used hemosorption (purifying the blood through charcoal filters), plasmapheresis, transfusion of Packed red blood cells, washed red blood cells. With extremely severe immediately after birth is administered corticosteroids and continues hormone therapy during the first weeks of life. In milder forms of hemolytic disease limited to tranfusion of glucose, protein drugs, the introduction of drugs that improve the functioning of the liver.

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    GBN threat its most serious complications – the death of the fetus or newborn, cerebral palsy, loss of hearing, vision, mental disabilities. It is important to carry out prevention of diseases during pregnancy of the mother. It is necessary to identify the presence of antibodies and to monitor their titer. In case of rise in antibody titer treatment: hemoperfusion, in some cases, exchange blood transfusion in utero: the fetal blood is replaced by the washed red blood cells of RH-negative blood.

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