Heat Denaturation Temperatures above 47°C cause direct damage to erythrocytes by denaturation of the cytoskeletal protein, spectrin. This can occur in patients with extensive burns. Within 24 h of the burns, acute hemolytic anemia can develop with gross hemoglobinuria and spherocytes and schistocytes on the peripheral blood smear.
March Hemoglobinuria This type of hemolysis can occur in soldiers and joggers and in karate and conga-drumming enthusiasts. Red blood cell destruction is the result of direct trauma to the cells in the vessels of the feet or hands. These patients rarely become anemic but do have hemoglobinuria after strenuous exercise or activity.
Cardiopulmonary Bypass Patients who have been on cardiopulmonary bypass can develop a postperfusion syndrome that consists of acute intravascular hemolysis, leukopenia, and fever. This hemolysis is thought to result from the activation of complement as blood passes through the oxygenator.
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