marching hemoglobinuria
Introduction
Introduction to marching hemoglobinuria Marching hemoglobinuria is a condition in which the red blood cells are mechanically damaged due to repeated severe impacts on the palms, soles or other parts of the body and hard objects, resulting in transient intravascular hemolysis and hemoglobinuria. basic knowledge The proportion of sickness: 0.01%-0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: urethritis
Cause
Marching hemoglobinuria
Environmental factors (35%):
It mainly occurs in a variety of activities in an upright position, such as long-distance marching, step-by-step training, long-distance running, walking, playing on hard ground, karate competition, and continuously hitting sandbags or tambourines.
Occupational factors (65%):
Peking Opera Wusheng actor has been continually small, and some people even reported that a patient with Alzheimer's disease had hemoglobinuria after repeated head impact on the wall. Swimming and cycling athletes were extremely rare.
Pathogenesis
From the various situations mentioned above, it can be seen that repeated impact on a hard surface by a certain part of the body can trigger marching hemoglobinuria. The exact pathogenesis is not fully understood. On the one hand, when the red blood cells flow through the soles of the feet, the palms and other parts are superficial. When the blood vessels are damaged by mechanical damage, on the other hand, the superficial microvessels of the soles of the feet and palms may be damaged when subjected to repeated forceful attacks. The microvessels are narrowed and rough, and the red blood cells flowing through are excessively pushed and torn. Splitting, which causes hemolysis, the occurrence of this disease is mainly related to the degree of hardness of the moving ground or the surface of the hitting object, the movement mode or posture, and the patient who has hemoglobinuria after running on the hard road is better in the grass or wearing elasticity. The sneakers perform the same activities, but the different movements of the same amount of exercise, the impact on the body, and the degree of mechanical damage to the red blood cells are different.
Everyone's gait and landing weight are different. Some people have a large impact force on the soles of the feet. These people are prone to hemolysis, but these patients may also have some predisposing factors, such as defects in the erythrocyte membrane. Or the serum conjugated globin level is low and the free hemoglobin binding ability is insufficient. It has been found that the glutathione reductase and glutathione peroxidase are temporarily deficient in the disease, which makes the erythrocyte lipid peroxidation, but it is difficult to explain The relationship with this disease.
Prevention
Marching hemoglobinuria prevention
Should be based on prevention, in the future exercise wearing elastic shoes of appropriate thickness, choose the appropriate venue, correct bad posture, adjust the amount of exercise to reduce or avoid recurrence.
Complication
Marching hemoglobinuria complications Complications urethritis
Total bilirubin is slightly elevated and serum lactate dehydrogenase is elevated.
Symptom
Marching hemoglobinuria symptoms common symptoms urinary tract burning sensation proteinuria hemoglobinuria low molecular proteinuria
Hemoglobinuria after exercise is often the only manifestation of the patient. It usually occurs between 30min and 5h after exercise. After 6~12h, the urine color can return to normal. When hemoglobinuria occurs, it may be accompanied by lumbar soreness or slight pain. Symptoms such as burning sensation of the urinary tract, the hemolysis of this disease is transient, and the duration is short. Although it can be repeatedly exercised for several weeks or several months, it can disappear after stopping the exercise.
Examine
Progressive hemoglobinuria examination
1. Abnormal red blood cells can be seen in the peripheral blood, and there may be mild reticulocyte increase.
2. The red blood cell osmotic fragility test is normal.
3. Free hemoglobin is elevated, and haptoglobin is decreased.
4. Total bilirubin is slightly elevated and serum lactate dehydrogenase is elevated.
5. Positive urine occult blood, hemosiderin particles may appear in the urine.
Diagnosis
Diagnosis and identification of marching hemoglobinuria
diagnosis
According to the characteristics of clinical manifestations and laboratory tests, the disease can be diagnosed.
Differential diagnosis
1. The identification of marching hemoglobinuria and paroxysmal cold hemoglobinuria is easier. Paroxysmal nocturnal hemoglobinuria can be aggravated by exercise, pay attention to the identification of this disease.
2. After exercise, myoglobinuria patients often have strong myalgia and tenderness. Myoglobin has a small molecular weight and is easily excreted from the kidney. The concentration of plasma-bound globin does not decrease during the onset. Careful extraction of plasma, myoglobinuria The plasma appearance is normal and the plasma of hemoglobinuria is reddish brown. In addition, due to the different molecular weights of the two, the electrophoresis speeds are different, and myoglobin is soluble in 80% ammonium sulfate saturated solution, while hemoglobin cannot. Identification based on these different physical and chemical properties.
