left for this molecule to be bound with hemoglobin. The CBC will show reduced hemoglobin, hematocrit, and red cell count in response to excessive red cell destruction, and the reticulocyte count is elevated in response to the erythroid hyperplasia of the bone marrow. Retic-ulocytes are released prematurely in response to the red cell need in anemic conditions; therefore, the reticulo-cyte count is almost always elevated. Additionally, LDH is increased. LDH is a red blood cell enzyme that will increase in the plasma as red blood cells are lysed prematurely. Hemoglobinemia may appear as red-tinged plasma, because the red cells have burst directly inside the vessels; consequently, centrifuged blood samples may have a red or pink-tinged plasma component. Hemoglobinuria is a direct representation of free hemoglobin being filtered by the kidney into the urine; therefore, urine samples may be blood tinged. Intravascular events may take as long as 48 hours to manifest through laboratory results. Many of the same processes that occur in intravascular events may occur in extravascular hemolysis, with the exception of hemoglobinuria and hemoglobinemia. Additionally, the spleen may become enlarged in extravascular hemolysis because damaged red cells may become sequestered in this organ.
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