| CASE REPORT |
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| Year : 2020 | Volume
: 17
| Issue : 3 | Page : 86-88 |
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An interesting story of intravascular hemolysis but normal haptoglobin and bilirubin levels
Kriti Chauhan1, Nikhil Shandilya2
1 Department of Pathology, Polo Labs, Ivy Hospital, Panchkula, Haryana, India
2 Department of Critical Care, Alchemist Group of Hospitals, Panchkula, Haryana, India
Correspondence Address:
Dr. Kriti Chauhan
Polo Labs, Ivy Hospital, MDC, Sector 5C, Panchkula - 134 112, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcls.jcls_76_19
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Multiple bee stings are associated with intravascular hemolysis (IVH), rhabdomyolysis, hypotension, renal tubule injury, and all causing acute kidney injury. Evidence in support of hemolysis includes anemia, hyperbilirubinemia, hemoglobinemia, hemoglobinuria, low haptoglobin (Hp) levels, elevated lactate dehydrogenase, and Coomb's test (if antibody mediated). However, under certain circumstances, hemoglobinemia and hemoglobinuria may be the only evidence of IVH depending on the etiological factors in association with the environment inside the body. Bee venom is known to have deleterious actions on different tissue types (neurotoxin, muscle paralytic, hematotoxic, epithelial damage, etc.). Altogether, they determine the outcome and presentation. Apart from this, there are several conditions that determine the binding of oxygen and Hp to hemoglobin (Hb). Arterial blood gases (ABGs) play a very important role in this. Hence, it is important for the pathologists to have an understanding of ABG as well to know how even simple tests (Hb, bilirubin, and Hp) can get affected by them. We describe one such occurrence in a patient with multiple hornet bee stings and formulate the likely causes and pathogenesis.
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