Background: Cell-free hemoglobin (CFH) and free heme are potent mediators of endotheliopathy and organ injury in sepsis, but their roles in other hemolytic pathologies are not well-defined. A prime example is trauma where early hemolysis may initiate damage and predict outcome. Here, we investigated the presence of plasma CFH, heme, and their major scavengers after traumatic injury.
Methods: Adult patients who presented as highest-level activations were prospectively enrolled at a level 1 trauma center between 2021 and 2023. Venous blood was collected upon arrival (pretransfusion) and 6, 12, and 24 hours after admittance for quantification of CFH, haptoglobin, heme, and hemopexin.
Results: We studied 119 mostly male subjects (101:18) with a median age of 48 years (interquartile range [IQR], 31-64 years) and an Injury Severity Score of 22 (IQR, 11-29); the majority had suffered blunt force trauma. The 28-day mortality rate was 11%. Cell-free hemoglobin was high upon emergency department arrival (10.9 μM; IQR, 6.8-17.6) and then declined but remained elevated compared with normative levels during the monitoring period (>5 vs. ~0.2 μM). The initial drop in CFH was attributed to haptoglobin binding and clearance. Notably, there was a subgroup of patients with two- to threefold higher levels of CFH on emergency department arrival (median, 25 μM). Patients with these highest CFH levels had longer hospital stays and more frequent complications.
Conclusion: Cell-free hemoglobin is elevated in trauma patients very early after injury and may impact outcome. While further work is needed, early correction of hemolysis could provide benefit.
Level Of Evidence: Prognostic Study; Level III.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0000000000004543 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Predictive Potential of ECMO Blood Flow for Hemolysis and Outcome of Patients with Severe ARDS.
J Clin Med
December 2024
Department of Anesthesiology and Intensive Care Medicine CCM/CVK Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Treatment with veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a frequently considered rescue therapy in patients with severe acute respiratory distress syndrome (ARDS). Hemolysis is a common complication in patients treated with ECMO. Currently, it is unclear whether increased ECMO blood flow (Q̇) contributes to mortality and might be associated with increased hemolysis.
View Article and Find Full Text PDFAssociation of LVV-Hemorphin-7 with Sepsis and Shock: Roles of Cathepsin D and G in Hemoglobin Metabolism in a Prospective ICU Cohort Study.
Biomedicines
December 2024
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
Background: Sepsis is a leading cause of mortality in intensive care units (ICUs). Cell-free hemoglobin (CFH) released during sepsis interacts with lysosomal enzymes from neutrophils and macrophages. This study aims to examine the association of LVV-hemorphin-7 (LVV-H7), cathepsin D, and cathepsin G with sepsis and shock in ICU patients.
View Article and Find Full Text PDFCell-free hemoglobin released from hemolysis induces programmed cell death through iron overload and oxidative stress in grass carp (Ctenopharyngodon idella).
Fish Shellfish Immunol
January 2025
Guangdong Provincial Water Environment and Aquatic Products Security Engineering Technology Research Center, Guangzhou Key Laboratory of Aquatic Animal Diseases and Waterfowl Breeding, College of Animal Sciences and Technology, Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong Province, 510222, China. Electronic address:
Intravascular hemolysis releases hemoglobin (Hb) from red blood cells under specific conditions, yet the effect of hemolysis in aquaculture systems remain poorly understood. In this study, a continuous hemolysis model for grass carp was established by injection of phenylhydrazine (PHZ) to investigate the mechanistic impacts of sustained hemolysis. PHZ-induced hemolysis altered liver color, and subsequent hematoxylin and eosin staining revealed substantial Hb accumulation in the head kidney, accompanied by inflammatory cell infiltration and vacuolization in liver tissue.
View Article and Find Full Text PDFCirculating biomarkers associated with pediatric sickle cell disease.
Front Mol Biosci
December 2024
Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States.
Introduction: Sickle cell disease (SCD) is a genetic blood disorder caused by a mutation in the HBB gene, which encodes the beta-globin subunit of hemoglobin. This mutation leads to the production of abnormal hemoglobin S (HbS), causing red blood cells to deform into a sickle shape. These deformed cells can block blood flow, leading to complications like chronic hemolysis, anemia, severe pain episodes, and organ damage.
View Article and Find Full Text PDFElevated cell-free hemoglobin: A novel early biomarker following traumatic injury.
J Trauma Acute Care Surg
December 2024
From the Department of Surgery (J.T.R.), and Blood, Heart, Lung, and Immunology Research Center (J.T.R., K.E.R.), University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Surgery (A.J.R., A.B., A.R.B., R.A.C.), University of California Davis, Sacramento, California; Department of Anesthesia and Critical Care (A.M., N.N.), Pontchaillou University Hospital of Rennes, Rennes, France; Department of Anesthesiology and Perioperative Medicine (J.D.R.), University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; and Division of Pulmonary Critical Care Medicine, Department of Medicine (K.E.R.), University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Background: Cell-free hemoglobin (CFH) and free heme are potent mediators of endotheliopathy and organ injury in sepsis, but their roles in other hemolytic pathologies are not well-defined. A prime example is trauma where early hemolysis may initiate damage and predict outcome. Here, we investigated the presence of plasma CFH, heme, and their major scavengers after traumatic injury.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!