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Hp irreversibly binds to Hb and impedes its filtration in the kidneys59 and its translocation to the endothelium,60 which counteracts its harmful effects.61 Hp can also bind to Mb, but with less affinity that it does to Hb.62 The HbHp binding promotes the interaction and subsequent internalisation of this complex through the CD163 receptor of the membrane, which is present in monocytes and macrophages.63 Hp levels are highly reduced in patients with chronic haemolysis, such as SCA,64 because Hp breaks down after being endocited.65 The importance of this protein for Hp has been reported in gene knockout studies in rats, which are more sensitive to damage from haemolysis.59 Studies in animal models of SCA and rhabdomyolysis have shown that the administration of Hp reduces vaso-occlusion,31 oxidative stress66 and renal damage.60,67,68 CD163 CD163 is a receptor found on the surface of circulating monocytes and macrophages, whose main function is Hb clearance in tissue.63 CD163 has a high affinity for HbHp complexes, although it can also bind to free Hb.69 The macrophages that express CD163 have reduced hydrogen peroxide release and important anti-inflammatory functions through the production of IL-10 and HO-1 stimulation.70 Our group has observed an increase in the macrophages expressing CD163 in renal biopsies of patients with massive haemolysis, such as paroxysmal nocturnal haemoglobinuria37 and favism.39 The renal expression of CD163 was higher in areas where iron had accumulated and where oxidative stress markers were found

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The correct draw is 37.5 units