Hemoglobin is an important element of red blood cells. It is a protein that carries oxygen and helps to oxygenate tissues all over the body. In some areas it should not be present in large supply, such as in excreted urine. When hemoglobin is found in urine this is called hemoglobinuria, and it may be suggest many different medical conditions. There are a couple of diseases called hemoglobinuria (paroxysmal nocturnal and paroxysmal cold hemoglobinuria), yet the presence of hemoglobin in urine doesn’t have to be associated with either of these diseases.
Paroxysmal nocturnal and paroxysmal cold hemoglobinuria are rare disorders that aren’t that related to each other. Both describe the onset of conditions where blood cells begin to break down very quickly. In the nocturnal form the condition may occur at any time. A common symptom that this disease is occurring is very dark or red morning urine since it contains more concentrated hemoglobin levels.
Over time other symptoms of the condition emerge, including pale skin, rapid heart rate, and fatigue. Blood may form clots easily, leading to stroke risk, or people may bleed more readily and be subject to over-bleeding from injuries. White blood cell count often drops too, which can lead to frequent infections. Risk of certain cancers becomes higher, and those with this condition are prone to developing leukemia. There are treatments that improve survival rate, including medication that may help arrest the process of the blood breaking down. Moreover some people can be cured of this condition by getting a bone marrow transplant.
Paroxysmal cold hemoglobinuria is quite different and may be caused by the combined effects of exposure to cold and infection with syphilis or other illnesses. Again red blood cells break down, but they often do so most in the extremities (feet and hands). This usually only occurs when a person transitions from a cold temperature to a warmer one, like from outside to inside. Symptoms of this condition include blood passed in urine or dark urine, flu-like symptoms, pain in the stomach, head, back and legs, and often chills and/or fever. Treatment may be simpler when this illness is diagnosed and provided the underlying condition can be treated, this form of hemoglobinuria may not recur.
There are so many other diseases that can have hemoglobinuria as a symptom. It could happen in something relatively minor and curable, such as a treatable kidney infection. More often, illness is severe and includes sickle cell anemia, inflammation of the kidneys (acute nephritis and usually glomerulonephritis), tumors in the kidneys, thalassemia (production of abnormal hemoglobin protein), or sudden reaction to blood transfusions. Sometime people with injuries that have crushed parts of the body develop this condition and other times severe burns may create hemoglobinuria.
Given the vast number of causes, treatment has to depend on each individual’s circumstances. It should be very clear though that people presenting with signs of this condition need immediate treatment. Allowing continued depletion of red blood cells or sudden destruction of them is not compatible with sustaining health.