Summary
In 27 (78%) of 36 patients with massive hemolysis (defined as a fall in hematocrit of more than 12% within 12 h due to intravascular red cell destruction), hypertriglyceridemia (plasma triglycerides > 175 mg/dl) was present or appeared within two days after the hemolytic crisis. Eighteen subjects with triglycerides exceeding 300 mg/dl (peak 516 ± 39 mg/dl) were further analyzed. The development of hyperlipidemia was independent of the etiology of hemolysis (microangiopathic hemolytic disease 7, toxicemia 3, parainfectious complications 3, autoimmune hemolysis 2, glucose-6-phosphate dehydrogenase deficiency 2). Factors known to increase plasma triglycerides, such as shock, infections, or pancreatitis, were present in only a few cases. Hemolysis-associated complications were activation of intravascular coagulation (16), coma (13), acute renal failure (13), and respiratory insufficiency (5), organ dysfunctions indicating diffuse microvascular injury. Plasma triglycerides fell within a few days if the cause of red cell destruction was eliminated. In 5 of the 8 patients presenting with triglycerides below 175 mg/dl, severe hepatic dysfunction was present. We conclude that hemolysis causes transient hyperlipidemia, either directly by red cell destruction or indirectly by inducing intravascular coagulation, and possibly due to both increased triglyceride synthesis and decreased catabolism.
Similar content being viewed by others
References
Baker WF (1989) Clinical aspects of disseminated intravascular coagulation. Semin Thromb Hemost 15:1–57
Carvalho AC, Lees RS, Vaillancourt RA, Cabrai RB, Weinberg RM, Colman RW (1976) Intravascular coagulation in hyperlipidemia. Thromb Res 8:843–857
Druml W, Laggner AN, Widhalm K, Kleinberger G, Lenz K (1983) Lipid metabolism in acute renal failure. Kidney Int 24 [Suppl 16]:S139-S142
Druml W, Laggner AN, Lenz K, Grimm G, Schneeweiß B (1991) Pancreatitis in massive hemolysis. Ann Hematol (in press)
Eckel RH (1989) Lipoprotein lipase. A multifunctional enzyme relevant to common metabolic diseases. N Engl J Med 320:1060–1068
Feingold KR, Soued M, Serio MK, Moser AH, Dinarello CA, Grunfeld C (1989) Multiple cytokines stimulate hepatic lipid synthesis in vivo. Endocrinology 125:267–274
Fulop M, Eder HA (1989) Plasma triglycerides and cholesterol in diabetic ketosis. Arch Int Med 149:1997–2000
Gallin JI, Kaye D, O'Leary WM (1969) Serum lipids in infections. N Engl J Med 281:1081–1086
Goldfinger D (1977) Acute hemolytic transfusion reactions — a fresh look at the pathogenesis and considerations regarding therapy. Transfusion 17:85–97
Huth K (1971) Fettstoffwechselstudien bei der experimentellen Verbrauchskoagulopathie. Thromb Diath Haemorrh [Suppl 50]:99–104
Kessler JI, Miller M, Barza D, Mishkin S (1967) Hyperlipemia in acute pancreatitis. Am J Med 42:968–976
Kihara S, Matsuzawa Y, Kubo M, Nozaki S, Funahashi T, Yamashita S, Sho N, Tarui S (1989) Autoimmune hyperchylomicronaemia. N Engl J Med 320:1255–1258
Martin W, Villani GM, Jothianadan D, Furchgott RF (1985) Selective blockage of endothelium-dependent and glyceryl trinitrate-induced relaxation by hemoglobin and by methylene blue in the rabbit aorta. J Pharmacol Exp Ther 232:708–716
Rabiner SF, Friedman LH (1968) The role of intravascular hemolysis and the reticuloendothelial system in the production of a hypercoagulable state. Br J Haematol 14:105–109
Sadrzadeh SMH, Graf E, Panter S, Hallaway PE, Eaton JW (1984) Hemoglobin. A biologic Fenton reagent. J Biol Chem 259:14354–14356
Watson AJ (1970) Genesis of fat emboli. J Clin Pathol 23 [Suppl 4]:132–142
Wilson WA, Thomas EJ (1979) Activation of the alternative pathway of human complement by hemoglobin. Clin Exp Immunol 36:140–144
Whitaker AN, Bunce I, Knowles BR, Richardson ER (1974) Hyperlipidemia in experimental disseminated intravascular coagulation. J Trauma 14:116–125
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Druml, W., Grimm, G., Laggner, A.N. et al. Hyperlipidemia in acute hemolysis. Klin Wochenschr 69, 426–429 (1991). https://doi.org/10.1007/BF01666827
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF01666827