Hemoglobinuria
Synonym(s): Haemoglobinuria
Introduction
- Presence of free hemoglobin in the urine.
- Cause: hemoglobin filtered by the glomeruli (true hemoglobinuria), or hemoglobin released by lysis of erythrocytes in urine (hematuria).
- Signs: reddish discoloration of urine.
- Diagnosis: blood reaction on urine test strip; lack of erythrocytes in urine sediment; investigation of cause.
- Treatment: depends on cause.
- Prognosis: depends on cause.
Presenting signs
- Reddish discolored urine.
- Hematuria followed by lysis of erythrocytes in urine.
- Hemoglobinuria resulting from hemolytic anemia; usually accompanied by weakness, pallor and other signs.
Hemolytic anemia in cats is not always accompanied by hemoglobinuria unless rapid and/or severe hemolysis occurs.
Acute presentation
- Acute hemolysis may result in collapse and cyanosis.
Geographic incidence
- Depends on cause eg infectious diseases such as babesiosis are more common in certain countries.
Breed/Species predisposition
- Spontaneous hemolytic anemia in Siamese Siamese kittens.
Pathogenesis
Etiology
Erythrocyte lysis within urine
- Hematuria Hematuria.
Intravascular hemolysis
- Hemoglobin filtered by glomeruli.
- Intravascular hemolysis is more likely to result in hemoglobinuria than is extravascular hemolysis.
- Hemoglobinuria is more likely to result when hemolysis is severe and/or rapid.
- Idiopathic.
- Bacterial infection:
- Leptospirosis .
- Clostridiosis Clostridia spp.
- Streptococcal infection Streptococcus spp.
- Red blood cell parasite infection:
- Babesiosis - intravascular hemolysis predominates Babesia felis.
- Hemobartonellosis (feline infectious anemia) Feline infectious anemia.
- Chemicals and drugs:
- Phenothiazine.
- Methylene blue.
- Paracetamol Paracetamol.
- Copper.
- Ricin.
- Immune-mediated:
- Myeloproliferative or lymphoproliferative diseases Lymphoproliferative disease.
- Hemolysis associated with feline leukemia virus infection Feline leukemia virus disease.
- Neonatal isoerythrolysis Neonatal isoerythrolysis.
- Incompatible transfusion Blood transfusion.
- Hypo-osmolarity.
- Cold-induced hemoglobinuria.
- Increased red cell fragility:
-
- Toxemia.
- Heat stroke.
- Radiation.
Extravascular hemolysis
- Red blood cell parasite infection:
- Babesiosis Babesia felis.
- Hemobartonellosis Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis' - extravascular hemolysis predominates.
- Immune-mediated:
- Autoimmune hemolytic anemia Anemia: immune-mediated hemolytic.
- Systemic lupus erythematosus Systemic lupus erythematosus.
- Cold agglutinin disease Cold agglutinin disease.
- Intracorpuscular defects:
- Congenital erythropoietic porphyria - autosomal dominant inheritance.
- Spontaneous hemolytic anemia associated with hemoglobin crystalloid formation in Siamese kittens.
- Fragmentation (microangiopathic disorders):
- Disseminated intravascular coagulation .
- Hepatic cirrhosis Liver: cirrhosis.
Pathophysiology
- Hemoglobinuria may result from either of two main sources:
- True hemoglobinuria results when hemoglobin is filtered by the glomeruli.
- Hemoglobinuria also results from hematuria Hematuria when erythrocytes are lysed within the urine.
- True hemoglobinuria caused by intravascular or extravascular destruction of erythrocytes → release of hemoglobin into plasma.
- Hemoglobin is a metalloprotein of molecular weight 64,500 → small enough to pass the glomerular filter.
- Severe or moderate intravascular hemolysis → free hemoglobin appears in urine.
- Most of the free hemoglobin in urine is probably secreted as a dimer.
- True hemoglobinuria is usually accompanied by clinical signs of hemolysis.
- Hemoglobinuria results from hemolysis only when erythrocytes are destroyed at a rate exceeding the capacity of conversion of hemoglobin to bilirubin → many patients with hemolysis will have bilirubinemia and icterus rather than hemoglobinuria.
Timecourse
- A few hours to several weeks, depending on cause and severity.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Bobade P A, Nash A R & Rogerson P (1988) Feline haemobartonellosis - clinical, hematological and pathological studies in natural infections and the relationship to infection with feline leukaemia virus. Vet Rec 122 (2), 32-36 VetMedResource.
Other sources of information
- Loar A S (1994) Anaemia - diagnosis and treatment. In: Consultations in Feline Internal Medicine II Philadelphia: W B Saunders Co, pp.469-487. ISBN 0 7216 4674 3.