Hemolytic Poisons

HEMOLYTIC POISONS, substances that dissolve red blood cells in the bloodstream. At present, this concept has been expanded to include substances that do not dissolve blood elements in the bloodstream but merely damage them, since under the action of both types, the main mass of erythrocytes is destroyed not in the bloodstream but in the cells of the reticuloendothelial apparatus. The symptoms of poisoning by both types of these poisons are also the same, except for hemoglobinemia and hemoglobinuria under the action of poisons of the first group. According to the method of combination with blood cells and the mechanism of action, hemolytic poisons are divided into 4 groups: 1. Metals that combine with blood proteins and form albuminates, for example, lead, mercury. 2. Substances that combine with the fat elements of blood cells but do not dissolve fats, for example, metalloids, alkaloids, bacterial toxins. 3. Substances that combine with the fat elements of blood and dissolve fats, for example, glycosides, chloroform, ether, carbon disulfide, benzene, gasoline. 4. Poisons that disrupt osmotic equilibrium in the cell: distilled water. Under the influence of H. poisons, not only red but also white blood cells are destroyed. The quantity of H. poisons is extremely large. Numerous representatives of them are found among inorganic substances. The main mass, by origin, belongs to the plant and animal world. The strength of some poisons is very great: 1 gram of cobra poison is sufficient to kill 165 adult people. Many H. poisons are formed in the human body not only under pathological conditions but also under normal conditions. Such poisons include bile acids and their salts. The intestine is a constant laboratory for H. poisons - in it, during the breakdown of food protein, as well as as products of bacterial life activity (especially the bacillus coli), numerous H. poisons of varying strength are formed. In addition, a number of bacteria form toxins of hemolytic nature: the tuberculosis bacillus, the typhoid bacillus, the paratyphoid bacillus, the staphylococcus, and especially the streptococcus. The main general symptoms in poisonings by H. poisons are: increased content of urobilin in the blood and bile, poikilocytosis, anemia with subsequent intensification of regeneration of blood elements. On autopsy, the following are found: hemosiderosis of the liver, bone marrow, and spleen, transition of yellow bone marrow into active red, formation of additional foci of hematopoiesis in parenchymal organs. With some poisons, the most vivid symptom is not so much hemolysis as other phenomena, for example, transition of Hb into methemoglobin (Berthollet's salt), formation of carbon monoxide hemoglobin, formation of iron sulfide compounds in erythrocytes (carbon disulfide), because of which signs of cell suffocation come to the forefront. Under the influence of hemolytic poisons, not only a decrease in the number of erythrocytes but also an increase can occur, since H. poisons in small doses have the ability to irritate the bone marrow, which is why for the treatment of anemia have been proposed: arsenic, phenylhydrazine, hemolytic serum. In chronic poisonings by H. poisons, a so-called habituation develops, and the body does not react acutely to them (for example, immunity to snake venom, habituation to phenylhydrazine, gasoline, etc.). The mechanism of habituation is extremely complex and different for each poison. Many poisons are neutralized already in the bloodstream, combining with cholesterol (insoluble saponin-cholesteride). The blood is cleared of other poisons by means of enhanced activity of reticuloendothelial cells that capture the poison (metalloids). Many poisons undergo chemical processing; the organ that most energetically neutralizes poisons is the liver. Finally, poisons are excreted by the lungs, kidneys, and liver (with bile), as well as by the walls of the large intestine. In chronic poisonings by H. poisons, the ability to neutralize poisons increases several times. H. poisons have great importance in professional pathology, since in a number of productions, under working conditions, one has to deal with hemolytic poisons.