Which one of the following is not raised in intravascular hemolysis?-
## **Core Concept**
Intravascular hemolysis refers to the process where red blood cells are destroyed within the blood vessels. This leads to the release of various intracellular components into the bloodstream. Key markers and consequences of intravascular hemolysis include elevated levels of lactate dehydrogenase (LDH), decreased haptoglobin, increased indirect bilirubin, and the presence of schistocytes on a blood smear.
## **Why the Correct Answer is Right**
In intravascular hemolysis, red blood cells are destroyed within the vascular space, releasing their contents directly into the bloodstream. This results in:
- Elevated **LDH** (lactate dehydrogenase) due to leakage from lysed red cells.
- Decreased **haptoglobin** as it binds free hemoglobin released from lysed red cells, and the complex is then removed from the circulation.
- Elevated **indirect (unconjugated) bilirubin** because the breakdown products of hemoglobin are processed in the liver, leading to an increase in this form of bilirubin.
## **Why Each Wrong Option is Incorrect**
- **Option A:** LDH is indeed raised in intravascular hemolysis, making it an incorrect choice for what is not raised.
- **Option B:** Haptoglobin levels decrease in intravascular hemolysis because it binds to free hemoglobin, forming a complex that is rapidly cleared from the circulation. Therefore, it's not what is raised.
- **Option C:** Indirect (unconjugated) bilirubin is raised due to the breakdown of hemoglobin from lysed red blood cells. This makes it an incorrect choice.
- **Option D:**
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that in intravascular hemolysis, you would expect to see **schistocytes** (fragmented red blood cells) on a peripheral blood smear, elevated **LDH**, and **indirect bilirubin**, along with **low haptoglobin**. These are critical diagnostic clues.
## **Correct Answer:** .