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Confirmation of intravascular hemolysis
Haptoglobin is an immunoglobulin-like plasma protein that binds hemoglobin. The haptoglobin-hemoglobin complex is removed from plasma by macrophages and the hemoglobin is catabolized. When the hemoglobin-binding capacity of haptoglobin is exceeded, hemoglobin passes through the renal glomeruli, resulting in hemoglobinuria.
Chronic intravascular hemolysis causes persistently low haptoglobin concentration. Regular strenuous exercise may cause sustained low haptoglobin, presumably from low-grade hemolysis. Low serum haptoglobin may also be due to severe liver disease.
Neonatal plasma or serum specimens usually do not contain measurable haptoglobin; adult levels are achieved by 6 months.
Increase in plasma haptoglobin concentration occurs as an acute-phase reaction. Levels may appear to be increased in conditions such as burns and nephrotic syndrome. An acute-phase response may be confirmed and monitored by assay of other acute-phase reactants such as alpha-1-antitrypsin and C-reactive protein.
Absence of plasma haptoglobin may therefore indicate intravascular hemolysis. However, congenital anhaptoglobinemia is common, particularly in African-Americans. For this reason, it may be difficult or impossible to interpret a single measurement of plasma haptoglobin. If the assay value is low, the test should be repeated after 1 to 2 weeks following an acute episode of hemolysis. If all the plasma haptoglobin is removed following an episode of intravascular hemolysis, and if hemolysis ceases, the haptoglobin concentration should return to normal in a week.
Low levels of plasma haptoglobin may indicate intravascular hemolysis.
Low haptoglobin is normal for the first 3 to 6 months of life.
Haptoglobin is an acute-phase reactant and increases with inflammation or tissue necrosis.
1. Silverman LM: Amino aicds and proteins. In Tietz Textbook of Clinical Chemistry. Edited by NW Tietz. Philadelphia, WB Saunders Company, 1986, pp 519-618
2. Kanakoudi F, Drossou V, Tzimouli V, et al: Serum concentrations of 10 acute-phase proteins in healthy term and preterm infants from birth to age 6 months. Clin Chem 1995;41:605-608
3. Siemens Nephelometer II Operations Instruction Manual. Siemens, Inc., Newark, DE