hemoglobinuria
Introduction
Introduction The urine contains free hemoglobin called hemoglobinuria. It is one of the evidences for diagnosing intravascular hemolysis. The urine contains free hemoglobin without red blood cells, or only a few red blood cells and contains a large amount of free hemoglobin. It reflects the fact that there is more than normal hemolysis in the blood vessels. Under normal circumstances, there is no detectable free hemoglobin in the urine. When the urine content is not equal, the urine color can be red, rich brown, and in severe cases, soy sauce color.
Cause
Cause
Causes of hemoglobinuria
First, the cause classification
1. Hemolysis in the urinary tract: If the relative density of urine is less than 1.006, the red blood cells are dissolved in the urine, and the urine color is red called pseudohemoglobinuria.
2. Renal infarction: hemolysis occurs in the infarct area, and hemoglobinuria is produced in the urine. This hemoglobinuria is characterized by hemoglobin and free hemoglobin combined with globin in the blood, and normal hemoglobinuria caused by intravascular hemolysis. .
3. Intravascular hemolysis: is the most important and most common cause of hemoglobinuria.
(1) Hemolytic anemia caused by congenital defects of red blood cells: whether it is a defect of red blood cells itself, or abnormal hemoglobin and erythrocyte enzymology, the following diseases are common: hereditary spherocytosis; hereditary oval red blood cells Increased symptoms. Hemolytic anemia caused by abnormal hemoglobin is seen in the absence of globin peptides such as Mediterranean anemia; abnormalities in bead proteins such as sickle hemolytic anemia. Enzyme defects in erythrocyte anaerobic glycolysis are found in hereditary non-spherical polycythemia; congenital hereditary red blood cells lack 6-phosphate glucose dehydrogenase to cause hemolysis such as faba bean disease. The most common acquired hemolytic anemia is paroxysmal nocturnal hemoglobinuria (PNH); paroxysmal cold hemoglobinuria; idiopathic chronic cold agglutinin disease; paroxysmal march hemoglobinuria.
(2) Blood transfusion reaction incompatible with blood type.
(3) bacterial infection: seen in sepsis, infectious bacterial endocarditis; protozoal infection common falciparum malaria, the disease is also known as black urine fever.
(4) Hemolysis caused by drugs and chemical agents: such as quinine, quinidine, chlorpromazine, phenacetin and other drugs. Chemicals and heavy metal salts are common benzoquinone, nitrobenzene, aniline, arsenic, arsine, lead and so on.
(5) Intravascular hemolysis caused by animal and plant factors: found in poisonous snake bites, poisoning poisoning.
Second, the mechanism of normal blood flow contains a small amount of hemoglobin, which is combined with haptoglobin in the form of a complex, because the molecule is large, can not be filtered out from the glomerulus; when the red blood cells in the blood are destroyed, the hemoglobin exceeds the globin When the amount can be combined, more than 15~25 mg in 100ml blood) there is more free hemoglobin in the blood circulation, which can be filtered through the glomerulus to form hemoglobinuria, which makes the urine color red, rich brown and soy sauce color.
Examine
an examination
Related inspection
Fecal phosphate urine hemosiderin qualitative test anti-neutrophil cytoplasmic antibody anti-islet cell antibody (ICA) Treponema pallidum antibody
When the urine content is not equal, the urine color can be red, rich brown, and in severe cases, soy sauce color.
Diagnosis
Differential diagnosis
Identification of symptoms confused by hemoglobinuria
1. Edema with proteinuria: edema with proteinuria edema with severe proteinuria is mostly renal edema. Mild proteinuria can also be seen in cardiogenic edema in addition to nephrotic edema. Edema during pregnancy, proteinuria is more common in gestational poisoning edema.
2. Hematuria with proteinuria: Renal hematuria refers to hematuria derived from glomeruli, clinical manifestations of simple hematuria, or hematuria with proteinuria. If the treatment is not thorough, repeated attacks or treatment failure, the condition can not be effectively controlled, and eventually lead to uremia.
3. Neonatal proteinuria: Generally, proteinuria in infants (under one year old) and children (from one year old to ten years old) is defined as daily urinary protein excretion greater than 110 mg/m2 and 85 mg/m2, respectively. Within a day, it is greater than 145mg/m2 to have proteinuria. Most of the lactating mother's medication can enter the baby through the milk, such as the concentration of the drug in the milk is too high.
