Analysis On Clinical Features Of Hemolytic Crisis And Significances Of LDH And STfR In Acute Hemolytic Anemia

Objectives: To summarize key points for the diagnosis of hemolytic cirisis by analyzing clinical data of children with acute hemolytic anemia(AHA) and to explore the significances of both LDH and soluable transferritin receptor (sTfR) in the diagnosis of AHA. Methods: Clinical data of 83 cases of children with AHA were studied retrospectively to evaluate causes, manifestations, laboratory findings, therapy and prognosis especially to evaluate clinical features of hemolytic crisis suggested by hematologic specialists based on various degree of AHA, Bechman autobiochemanalyser was used to determine LDH activity by enzyme method and sTfR were detected by ELISA in serum of AHA. Results: AHA was more in male than in female, it occured at any age and any season. G-6-PD deficiency was the top factor to cause AHA( 32.53%), the second was excerbation of thalassemia due to any stress (31.33%), ingestion of fava bean or infection was the major agent to trigger AHA, most of the patients presented with intermediate and severe anemia, average stay in hospital was 5.8 days and 98 % of the patients recovered from the hemolysis. 2. Clinical features varied with degree of hemolysis, fatigue, severe pallor, dyspenea, vomiting, dark urine(tea colored) and heart mumur were major signs and physical findings in the patients with Hb lower than 70g/L. There were no significant differences for serum potassium, CO2CP, GPT and reticulocyte count among various degrees of hemolysis (p>0.05), but WBC, BUN and LDH increased significantly as deterioration of hemolysis especially for the patients with Hb lower than 70g/L. 3. serum LDH: patients with AHA 541.03±271.24IU/L (n=32), normal control 109.43137.26 IU/L (n=16)(p<0.01); LDH activity increased as the anemia intensified, there was negative correlation between Hb concentration and serum LDH activity(r=-0.9932, p<0.01). 4. sTfR in the AHA (49.42±19.06nmol./L)(n=31) was significantly higher than that in the control(13.8±3.35nmol./L)(n=12)((p<0.01); there was positive correlation between sTfR content and reticulocyte count (r= 0.8011, p<0.001).Conclusion: AHA are more likely to occur in male than in female , G-6-PD deficiency and excerbation of thalassemia are major causes, the patients often present with intermeidiateand severe anemia, recovery from the acute episode is good with appropriate management. 2. key points for the diagnosis of hemolytic crisis are suggested (1) hemolytic anemia is demonstrateded (2) a patient with Hb lower than 70g/L show severe pallor, fatigue, vomiting ,...