 When a red blood cell lices, it releases its contents into your bloodstream. In the hospital, we identify hemolysis with a few different markers which are relevant to these dumped contents. For starters, high serum levels of the enzyme lactate dehydrogenase, or LDH. This enzyme is used for anaerobic ATP generation, converting lactate to pyruvate and vice versa. It is present in pretty much every cell in your body, so any degree of high cell turnover or cell death will result in elevated levels. Because RBCs rely solely on anaerobic respiration to get by, they have plenty of this enzyme, so when they rupture in the bloodstream, LDH will be notably elevated. Next up, look for low serum levels of the protein haptoglobin. This protein is mostly produced in the liver and acts to mop up free hemoglobin in the serum. If there's excess hemoglobin floating around, released from busted RBCs, haptoglobin levels will decrease as the protein is used up quicker than it can be synthesized by the liver. So after haptoglobin brings hemoglobin back to the liver, the heme protein is broken down by liver macrophages to bilirubin. If this is happening at an abnormally high rate, bilirubin will build up in the plasma. So we'll check for high levels of that as well. And lastly, we'll do a direct anti-globulin test, also known as Akum's test. The goal of this test is to determine if the patient's healthy RBCs have antibodies attached to them, meaning they've been tagged for destruction unnecessarily. So we add to the patient's blood this anti-globulin or anti-antibody, which is a mouthful, and then if the blood agglutinates or clumps up, that's a positive test result, meaning the patient has some degree of autoimmune hemolysis and are at risk of autoimmune hemolytic anemia. So just because the Akum's test or any of these other tests is positive, it doesn't mean that that person's got hemolytic anemia. Remembering back to our first video that we diagnosed the latter just by looking for low hemoglobin levels. If we find that in combination with any of these other findings, then we start to get worried about hemolytic anemia. And that's it for a little series on anemia. Thanks for watching. Hit subscribe, and we will see you next time.