Introduction
The body removes waste products from various metabolic processes through urine and feces. The kidneys play a significant role in filtering this waste and reabsorbing nutrients before disposing of it from the body. Certain medical conditions and drugs may cause changes in urine color with the abnormal presence of various particles in urine. For example, march hemoglobinuria is a condition with the presence of hemoglobin in urine resulting in red urine. There are multiple causes for the leakage or presence of blood in the urine. Hence, understanding the symptoms and causes is beneficial in the early diagnosis of the disease.
What Is Hemoglobin?
The body is made up of different types of cells to perform a specific function. For example, the blood contains various components, which include blood cells and plasma. There are three important blood cells that are:
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Red blood cells.
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White blood cells.
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Platelets.
The red blood cells are found circulating in the blood. The red blood cells are made up of a protein called hemoglobin. The timeline of red blood cells is one hundred and twenty days, after which they are broken down, and new cells are formed. The breakdown usually occurs in the liver, bone marrow, and spleen.
Composition of Hemoglobin:
Hemoglobin is composed of one globin molecule and four heme groups. Heme is a red pigment that primarily contributes to the red appearance of blood cells. Globin is a protein that protects heme.
Normal Range of Hemoglobin:
The normal values of hemoglobin are listed below:
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Males: 10 g/dl to 12 g/dl.
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Females: 12 g/dl to 15 g/dl.
Functions of Hemoglobin:
Hemoglobin helps carry oxygen to various organs; it comprises a cycle of events that exchange oxygen and carbon dioxide. It also helps in the acid-base balance. Low levels of hemoglobin can cause anemia. There are different types of anemia, and the most common cause is due to low levels of iron.
What Is Hemoglobinuria?
The excretion of hemoglobin in the urine is called hemoglobinuria. It occurs due to the excessive destruction of red blood cells resulting in free hemoglobin in urine. If there is excess hemoglobin, it may appear in the blood.
What Are the Symptoms of Hemoglobinuria?
The common symptoms of hemoglobinuria are listed below:
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Headache.
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Chest pain.
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Abdominal pain.
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Shortness of breath.
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Arrhythmia (irregular heartbeat).
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Easy bruising.
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Blood clots.
What Are the Causes of Hemoglobinuria?
Hemoglobinuria can occur in children as well as adults. The most common causes of hemoglobinuria are listed below:
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Infections: Certain viral or bacterial infections cause blood in the urine.
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Kidney Stones: Kidney stones are masses or collections of solid and calcified substances within the kidneys. Kidney stones are also known as renal stones, calculi, nephrolithiasis, and urolithiasis. It usually occurs due to diet, excess body weight, and certain medical conditions. Kidney stones typically vary in size depending on the mineral deposits. Smaller kidney stones are asymptomatic, whereas larger stones can be extremely painful, causing lower abdominal pain. Certain drugs help to dissolve the stone and pass them through the urine.
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Burns: In patients with accidental burn injuries, there is a loss of proteins. This is because proteins usually get denatured in heat. Denaturation is the process of breaking down protein bonds that form the basic structure of proteins.
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Sickle Cell Anemia: Sickle cell anemia is a genetic condition in which the red blood cells are sickle-shaped. The symptoms of sickle cell anemia are frequent infections, swelling of hands and feet, delayed growth, and visual problems. Treatment can help manage the symptoms of this condition.
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Kidney Tumor: Kidney tumors are growth in the kidneys, which may or may not be cancerous.
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Tuberculosis: Tuberculosis is a lung infection caused by bacteria. The common symptoms of tuberculosis are cough, fatigue, weight loss, night sweats, and fever.
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Transfusion Reaction: During blood transfusion (the process of transferring blood intravenously), there may be rejection resulting in hemolysis (destruction of red blood cells).
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Thalassemia: Thalassemia is a blood disorder. The symptoms of thalassemia are fatigue, weakness, paleness, and slow growth.
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Intravascular Hemolysis: In intravascular hemolysis, the red blood cells rupture, resulting in the leakage of contents into the surrounding fluids.
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Hemolytic Uremic Syndrome: Hemolytic uremic syndrome is a condition characterized by inflammation or damage to the blood vessels in the kidneys.
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Paroxysmal Nocturnal Hemoglobinuria: In paroxysmal nocturnal hemoglobinuria, the breakdown of red blood cells occurs earlier, resulting in the presence of hemoglobin in urine.
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Paroxysmal Cold Hemoglobinuria: In paroxysmal cold hemoglobinuria, the immune system eliminates the red cells by producing antibodies. Antibodies are proteins produced by the body when it detects an antigen (foreign particle).
What Is March Hemoglobinuria?
The term march was coined for hemoglobinuria as it was initially observed in army marches. It is the only hemoglobinuria that does not indicate any serious systemic disease.
What Are the Causes of March Hemoglobinuria?
March hemoglobinuria usually occurs in healthy young adults and is aggravated by walking and running. It usually occurs after marching on hard surfaces.
What Are the Symptoms of March Hemoglobinuria?
March hemoglobinuria is usually asymptomatic. However, occasionally the following symptoms are present:
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Cough.
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Abdominal cramps.
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Lumbar pain (pain in the lower back).
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Fatigue or tiredness.
What Is the Difference Between Hemoglobinuria and Hematuria?
Hematuria refers to bleeding in the urinary tract resulting in the presence of blood in urine, whereas hemoglobinuria is the presence of hemoglobin in the urine.
What Is the Diagnosis for Hemoglobinuria?
The diagnosis of hemoglobinuria includes the following methods:
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Hemoglobinuria Test - A hemoglobinuria test is done to detect the presence of hemoglobin in urine. A clean catch urine sample is required for the test. The clean catch urine method helps to prevent germs from entering the sample and thereby provides accurate results.
What Is the Treatment?
The appearance of blood in urine could be dreadful; however, it is treatable. The treatment of hemoglobinuria is mainly aimed at treating the underlying cause. Individuals are prescribed medications to prevent blood clots and boost the formation of red blood cells. The most commonly used drug in treating hemoglobinuria includes Eculizumab, which destroys red blood cells and decreases the risk of clot formation.
Conclusion
March hemoglobinuria refers to the presence of hemoglobin in urine. Hemoglobin is attributed to the oxygen capacity in the blood. So, loss of hemoglobin could cause an imbalance in the oxygen content, which may result in comorbidities eventually. Although it is not a grave condition, simple measures such as limited walking and running can help improve the condition, thereby alleviating the symptoms and improving the outcome.
