Traumatske hemolitične anemije: dva prikaza slučaja i pregled literature

Two patients with intravascular hemolysis are presented. One patient had traumatic hemolytic anemia after mechanical heart valve reimplantation, and the diagnosis was made rapidly and easily. In the other patient, the diagnosis was not so easy complex and time-consuming. This patient had both, traumatic hemolytic anemia caused by orthopedic prosthesis, and neutropenia. Fragmentation was caused by interaction of red blood cells with altered intravascular surfaces or by direct physical trauma to the cells due to excessive shear forces in the circulation. The following findings are seen in intravascular hemolysis: decreased hemoglobin, increased reticulocytes and lactic dehydrogenase, decreased serum haptoglobin, and presence of shizocytes in peripheral blood smear. Patients are considered to have intravascular hemolysis when lactic dehydrogenase is >460, along with the presence of two established criteria. If not causal, therapy is supportive.Prikazana su dvojica bolesnika s intravaskularnom hemolizom, od kojih je jedan imao hemolitičnu anemiju nakon ponovljene ugradnje mehaničkog srčanog zalistka i u kojega je dijagnoza bila brza i jednostavna. U drugoga je bolesnika postavljanje dijagnoze zahtijevalo dosta vremena i truda. Ovaj je bolesnik imao mehaničku hemolitičnu anemiju uzrokovanu ortopedskim protezama, ali i neutropeniju. Fragmentacija je bila izazvana interakcijom eritrocita s promijenjenom površinom žile ili izravnom fizikalnom traumom stanica u krvotoku. Kod intravaskularne hemolize prisutni su sljedeći nalazi: sniženi hemoglobin, povišeni retikulociti i laktat dehidrogenaza, sniženi haptoglobin u serumu, te prisutnost shizocita u razmazu periferne krvi. Smatra se da bolesnici imaju intravaskularnu hemolizu kada je laktat dehidrogenaza viša od 460, uz prisutnost dvaju utvrđenih kriterija. Ako nije etiološka, terapija je potporna