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Communications to the Editor |

Usefulness of Methemoglobin/ Haptoglobin Analysis in the Follow-up of Severe Immune Hemolytic Anemia FREE TO VIEW

Toshio Okazaki, PhD; Tatsuo Nagai, MD; Mitsuyuki Suzuki
Author and Funding Information

Affiliations: Kitasato University Graduate School of Medical Sciences Kitasato University School of Allied Health Sciences Kanagawa Prefecture, Japan,  National Taiwan University Hospital Taipei, Taiwan

Correspondence to: Toshio Okazaki, PhD, Department of Clinical Hematology, Kitasato University of Allied Health Sciences, 1-15-1 Kitasato, Sagamihara-shi, Kanagawa Prefecture 228-8555, Japan; e-mail: okazaki@ahs.kitasato-u.ac.jp



Chest. 2002;121(5):1724-1725. doi:10.1378/chest.121.5.1724
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To the Editor:

I was surprised and impressed by the dramatic improvement observed in a Coombs-positive hemolytic anemia patient reported by Kuo et al (June 2001).1This outstanding result seems to have resulted from the fact that haptoglobin functioned properly, thanks to the healthy liver, which minimized damage to the kidneys and other organs caused by the onset of anemia. However, we may not always achieve such successful results. In order to make a decision on whether or not to conduct the blood transfusion, it is important that anemia-induced hemoglobin loads to kidneys and other organs are correctly evaluated. Haptoglobin, which is produced mainly in the liver, combines with hemoglobin produced as a result of hemolysis. This haptoglobin-hemoglobin complex is then taken into the liver and metabolized there. However, the amount of haptoglobin produced is often not enough to keep up with excessive hemolysis. As a result, a state of ahaptoglobinemia is induced, as in this clinical case. Moreover, when excessive hemoglobin amounts continue to be released, the haptoglobin elimination mechanism cannot keep up and, eventually, another metabolic route begins functioning. In other words, hemes are removed from excessive hemoglobin to become methemes and combined with albumin to form methemalbumin, which is metabolized in the liver. In view of this metabolic flow, detecting haptoglobin/metheme is exceedingly useful in detecting the level of hemoglobin load in anemia patients. The detection of both haptoglobin and methemalbumin fractions in the serum from patients was conducted using 5% polyacrylamide gel electrophoresis and o-dianisidine staining method (Figure 1 ). The metheme concentration is directly proportional to the staining level of methemalbumin.2 This method allows simultaneous evaluation of both haptoglobin and metheme. Disappearance of haptoglobin and increase of metheme indicates extremely serious anemia. Detection of haptoglobin and methemalbumin contributes useful information for continued hemolysis follow-up.

Figure Jump LinkFigure 1. Zymogram of methemalbumin and haptoglobin on 5% polyacrylamide gel. Black arrows indicate ahaptoglobinemia electrophoretic patterns (1 and 2, methemalbumin-positive cases; 3, a methemalbumin-negative case). MHA = methemalbumin; Hp = haptoglobin; Hb = hemoglobin.Grahic Jump Location
Kuo, P-H, Yang, P-C, Kuo, S-S, et al (2001) Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy.Chest119,1961-1963. [PubMed] [CrossRef]
 
Nagai, T, Okazaki, T, Yanagisawa, Y Quantitative analysis of methemalbumin by polyacrylamide gel electrophoresis.Clin Lab1997;43,765-768
 
To the Editor:

We thank Dr. Okazaki and his colleagues for their interest in our article (June 2001).1 The reasons that corticosteroids and blood transfusion were not administered to our patient include his young age and the relatively well-preserved liver function and hemodynamics. We agree with Dr. Okazaki that we may not always achieve such successful results by antituberculosis therapy alone.

We think Dr. Okazaki also makes a good point that detecting haptoglobin/metheme is useful in the assessment of hemoglobin load in patients with hemolytic anemia. This laboratory procedure, however, is uncommon in current hematology practice. However, serial laboratory data of our patient showed that the serum level of lactate dehydrogenase, a common biochemistry index, was well correlated with the clinical course of hemolysis. In the status of hypohaptoglobinemia, lactate dehydrogenase may be an easy and sensitive marker for the severity and recovery of intravascular hemolysis.

References
Kuo, P-H, Yang, P-C, Kuo, S-S, et al Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy.Chest2001;116,1961-1963
 

Figures

Figure Jump LinkFigure 1. Zymogram of methemalbumin and haptoglobin on 5% polyacrylamide gel. Black arrows indicate ahaptoglobinemia electrophoretic patterns (1 and 2, methemalbumin-positive cases; 3, a methemalbumin-negative case). MHA = methemalbumin; Hp = haptoglobin; Hb = hemoglobin.Grahic Jump Location

Tables

References

Kuo, P-H, Yang, P-C, Kuo, S-S, et al (2001) Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy.Chest119,1961-1963. [PubMed] [CrossRef]
 
Nagai, T, Okazaki, T, Yanagisawa, Y Quantitative analysis of methemalbumin by polyacrylamide gel electrophoresis.Clin Lab1997;43,765-768
 
Kuo, P-H, Yang, P-C, Kuo, S-S, et al Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy.Chest2001;116,1961-1963
 
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