a yellowish staining of the skin, the whites of the eyes and deeper
caused by an increased presence of bilirubin (bile pigments) in the plasma of the blood.
This can be a result of excessive breakdown of red blood cells or liver disease such as hepatitis (also called icterus).
(FORMERLY KNOWN AS AUTOIMMUNE HEMOLYTIC ANEMIA or ?AIHA?) ... Is immune mediated red cell destruction is a cause of icterus
(FORMERLY KNOWN AS AUTOIMMUNE HEMOLYTIC ANEMIA or “AIHA”)
Immune-mediated hemolytic anemia is a condition where the patient’s immune system begins attacking its own red blood cells. What occurs on a microscopic level is this: the branch of the immune system that produces antibodies begins to direct them against the patient’s own red blood cells. The red blood cells become quickly coated with tiny antibody proteins, essentially marking these red blood cells for destruction.
When the cells circulate through the spleen, liver, and bone marrow, they are plucked from circulation and destroyed, a process called “extravascular hemolysis.” Their iron is sent to the liver as bilirubin for recycling. The spleen enlarges as it finds itself processing far more damaged red blood cells than it normally does. The liver is overwhelmed by large amounts of iron pigmented bilirubin and the patient becomes jaundiced.
Yellow pigmentation is jaundice
Making matters worse, a special protein system called the “complement system” is activated by these antibodies. Complement proteins are able to simply rupture red blood cells if they are adequately coated with antibodies, a process called “intravascular hemolysis.” Ultimately, there aren’t enough red blood cells left circulating to bring adequate oxygen to the tissues and remove waste gases. A life-threatening crisis has emerged; in fact 20-80% mortality (depending on the study) have been reported with this disease.
may run a test called a “packed cell volume”
Anemia due to poor red blood cell production by the bone marrow is called a “non-responsive anemia.” Such anemias are caused by chronic inflammatory diseases (like inflamed skin, infected teeth, or other long standing irritations), kidney failure, cancers of various types, or certain drugs (especially agents of chemotherapy).
Normally when red blood cells are lost, the drop in blood oxygen that results causes hormonal changes leading to increased production of red blood cells by the bone marrow. These are called “responsive anemias” because the bone marrow is responding. Bleeding and immune mediated red blood cell destruction are both “responsive anemias.”
THE TESTS SUGGEST IMMUNE MEDIATED
There are several clues in blood testing that tell us if our patient is bleeding or destroying red blood cells.
ICTERUS (ALSO CALLED “JAUNDICE”)
This is the yellow color that is taken up by a patient’s tissues when the liver is overwhelmed with bilirubin, the iron containing by-product of red blood cell destruction. Normally red blood cells are removed from the circulation when they become old and inflexible. Their iron is recycled in the liver. With so many red cells being destroyed, the liver is overwhelmed and bilirubin (a yellow pigment) spills out everywhere, coloring urine, gums, skin, and the eyes orange.
Is immune mediated red cell destruction the only cause of icterus? Absolutely not. Liver failure also leads to icterus when the diseased liver cannot process normal amounts of bilrubin. In cats especially, bacterial endotoxin (the toxic cell walls of certain types of infecting bacteria) can lead to icterus. Usually, however, an responsive anemia together with icterus, suggests immune-mediated red cell destruction.
A normal red blood cell is concave on both sides and disc like in shape. It is slightly paler centrally than on its rim. After a portion has been bitten off, it re-shapes into a more spherical shape with a denser red color. The presence of spherocytes indicates that red blood cells are being destroyed.
In severe cases of immune mediated hemolytic anemia, the immune destruction of red cells is so blatant that the red cells clump together (because their antibody coatings stick together) when a drop of blood is placed on a microscope slide. Imagine a drop of blood forming not a red spot but a yellow spot with a small red clump inside it. This finding is especially forboding.
spikes RBCs? * <---link
Classically, in IMHA the stimulation of the bone marrow is so strong that even the white blood cells lines (which have very little to do with this disease but which also are born and incubate in the bone marrow along side the red blood cells) are stimulated. This leads to white blood cell counts that are spectacularly high.
MORE TESTS NEEDED
COOMB’S TEST (ALSO CALLED A “DIRECT ANTIBODY TEST”)
This is a test designed to identify antibodies coating red blood cell surfaces. This test is the current state of the art for the diagnosis of IMHA but, unfortunately, it is not as helpful as it might seem. It can be erroneously positive in the presence of inflammation or infectious disease (which might lead to harmless attachment of antibody to red cell surfaces) or in the event of prior blood transfusion (ultimately transfused red cells are removed from the immune system). The Coomb’s test can be erroneously negative for a number of reasons as well. If the clinical picture fits with IMHA, often the Coomb’s test is skipped.
Fair Use *
THE FATIGUE of CFIDS ... 'checklist'
Consider this info to find the Autoimmune Hemolytic Anemia that often goes undetected in humans
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Many premature babies have jaundice after their birth.
I suspect it is something more serious than lack of Vitamin D & a little sunshine needed
Jaundice is also one of the signs of hemolytic anemia ... such as 2-butoxyethanol does cause
Is it 'in the family line?' Or has some new exposure occurred to 2-butoxyethanol (Vapors in baby's eyes)?
Fall, 2006 there was an article on how Chinese babies needed more vitamin D
They also have a HIGH incidence of Autism in their country
Look at the summer, 2005 Time magazine on manufacturing.
I suspect too much 2-butoxethanol in the air causes this high Autism rate & jaundiced babies
Look in this direction for 'bird flu' too