Hey, folks, just a quick reminder that this podcast is not meant to be used for medical advice,

just good old-fashioned education.

Welcome back, Clinical Problem Solvers.

This is another episode of the R-L-R series, which stands for...

Reza loves Robi loves Reza.

Vito, veto, delete.

As a reminder, this is where Reza and I sit, hang out, and talk through cases.

It is completely unscripted, poorly prepared, and hopefully

partially made up for by the spontaneity of the conversation. So we, Charmine usually

reminded us that this podcast is not for medical advice, and I would especially emphasize

that to be true for these spontaneous random discussions.

So now I'm going to kick off this episode by presenting a case to Raza.

And before you kick it off, Robbie, can you just, you were sharing with me this morning via

text message. You got lost in your river of blood. What was one interesting fact

you learned in reading about hemolysis this morning? You know, I was drowning in the river

of blood, quite frankly. I learned that our entry point for homilysis is usually anemia, but you could actually have RBC destruction

with a normal hemoglobin. How can that happen? Well, a couple of more intuitive ways is,

well, you start with a high hemoglobin, either because of polycythemia, true polycythemia, or relative polycythemia from volume contraction.

Or your bone marrow is healthy and well-fed and full of folate and B-12 and nice healthy stem cells.

And you can keep up with the rate of RBC destruction by pumping out reticulocytes.

And that's called compensated hemolysis.

So said simply, a normal hemoglobin does not exclude hemolysis.

...