Toxic hemolytic anemias

Toxic hemolytic anemia, or red blood cell hemolysis, can be caused by many chemicals and bacterial toxins.

Causes of toxic hemolytic anemia

Hemolysis is caused by chemicals such as:

• arsenic hydrogen;
• lead;
• copper salts (due to inhibition of the activity of pyruvate kinase and some other erythrocyte enzymes);
• potassium and sodium chlorates;
• resorcinol;
• nitrobenzene;
• aniline.

Cases of hemolytic anemia have been described after the bite of bees, scorpions, spiders, snakes (in particular, vipers). Very common and dangerous are poisonings by mushrooms, especially morels, fraught with severe acute hemolysis.

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The mechanism of hemolysis of erythrocytes

The mechanism of hemolysis in toxic hemolytic anemias may be different. Sometimes hemolysis develops as a result of a sharp oxidative effect (as in enzymopathic anemias), disruption of porphyrin synthesis, production of autoimmune factors, etc. Most often, intravascular hemolysis is observed in toxic anemias. Hemolytic anemias may also occur in infectious diseases. For example, malarial plasmodium is able to penetrate into erythrocytes, which are then eliminated by the spleen, and Clostridium welchii secretes a-toxin lecithinase, which interacts with membrane lipids of erythrocytes to form hemolytically active lysolecithin. Other options are also possible: absorption of bacterial polysaccharides on erythrocytes with subsequent formation of autoantibodies, destruction of the surface layer of the erythrocyte membrane by bacteria, etc.

Symptoms of toxic hemolytic anemia

Depending on the course, acute and chronic toxic hemolytic anemias are distinguished. In acute toxic hemolytic anemias, intravascular hemolysis occurs, manifested by hemoglobinemia, hemoglobinuria, and sometimes accompanied by collapse and anuria. One of the most striking models of acute toxic hemolysis is the so-called gyromitria syndrome, which occurs as a result of poisoning with mushrooms of the genus Gyromitra from the morel group - morels (Gyromitra esculenta, Common morel). In addition to acute intravascular hemolysis (DIC syndrome), gyromitria syndrome includes:

• gastrointestinal symptoms that appear in the first 6-24 hours after poisoning and last from 1 to 3 days;
• neurological syndrome with asthenia and severe headache;
• hyperthermia;
• hepatitis with pronounced cytolysis.

With this form of acute hemolysis, a fatal outcome is very likely.

Treatment of toxic hemolytic anemia

Treatment of toxic hemolytic anemia consists of stopping contact with the toxic agent or eliminating it (including, if possible, using an appropriate antidote), and in infectious diseases - adequate antibacterial or antifungal therapy. In severe anemia, replacement therapy is indicated. In addition, the patient needs emergency syndrome therapy (treatment of renal failure, hepatitis, neurological syndrome).