What is Marching Hemoglobinuria?
Marching hemoglobinuria is a rare form of mechanical hemolytic anemia with intravascular hemolysis due to injury of red blood cells in the capillaries of the feet. Hemoglobinuria, associated with prolonged walking, was first described in 1881. Later, there were many reports of this form of hemolytic anemia. Probably, it is quite rare – no more than 100 cases are published.
Pathogenesis during March Hemoglobinuria
In the mechanism of development of the disease remains a lot of unexplored. First of all, it is unclear what morphological changes in the feet lead to the development of march hemoglobinuria, why it occurs in some people when walking for a short distance, and in others it may be absent when running for several kilometers.
Symptoms of March Hemoglobinuria
Most of the patients described are men. Perhaps the predominance of men is due to the fact that the disease is more common in soldiers who have to walk for a long time.
The most important and often the only symptom of the disease is the appearance of black urine. Sometimes it does not disturb the general condition, but more often there are unpleasant feelings in the back, weakness in the legs, sometimes pain in the heels, vomiting. Temperature, as a rule, does not increase. Black urine appears shortly after a long walk, and usually after a few hours hemoglobinuria completely stops. After a long walk, such attacks appear again. The intervals between attacks range from 1-2 days to several years.
Diagnosis of March Hemoglobinuria
In most cases, the spleen probe fails. Renal failure does not develop. Sometimes the content of bilirubin is slightly elevated. Anemia in most cases does not happen, since the amount of destroyed blood does not exceed 40 ml. However, cases of mild anemia associated with frequent hemolytic crises are described.
At present, it has been proven that the erythrocytes of patients with marching hemoglobinuria are no different in biochemical properties from erythrocytes of healthy people. There is no reason to believe that immune disturbances are at the heart of march hemoglobinuria.
After running on a hard surface, there is a sharp overflow of heels with blood and a sharp burning sensation in the feet. In some individuals, hemoglobinuria occurs during short-term walking or running. No pathological changes in the red blood cells could not be detected. We can assume an unusual arrangement of the vessels of the feet, the proximity of the capillary network to the surface and, as a result, the trauma of the contents of these capillaries.
Treatment of March Hemoglobinuria
Treatment of the disease comes down to the recommendation to wear shoes with soft pads and refrain from walking or running for a long time.