THE PATHOGENESIS OF HEMOLYTIC ANEMIA: MOLECULAR AND CELLULAR MECHANISMS OF INTRAVASCULAR AND EXTRAVASCULAR HEMOLYSIS

This article examines the pathogenesis of hemolytic anemia, with particular emphasis on the molecular and cellular mechanisms of intravascular and extravascular hemolysis. It analyzes the physiological aging and pathological destruction of erythrocytes, damage to the cell membrane and cytoskeleton, oxidative stress, activation of the complement system, and the role of immune mechanisms in the development of hemolysis. Particular attention is paid to the processes involved in intravascular hemolysis, including the destruction of erythrocytes within blood vessels, the release of free hemoglobin into plasma, its binding to haptoglobin, and the reduction in the biological availability of nitric oxide (NO). In extravascular hemolysis, the mechanisms of erythrocyte recognition by macrophages in the spleen and liver, opsonization, phagocytosis, and partial removal of the erythrocyte membrane are discussed.