In such conditions, heme along with globin chains can be released from further oxidization of met-hemoglobin (ferric Hb). In which, the free heme can then accelerate tissue damage by promoting peroxidative reactions and activation of inflammatory cascades. At this time, hemopexin, another plasma glycoprotein come to bind with heme with its privilege of high heme affinity, forming a complex of heme-hemopexin, which is non-toxic, and travel together to a receptor on hepatocytes and macrophages within the spleen, liver and bone marrow. (Note that the "free hemoglobin-haptoglobin" complex is taken up by hepatocytes and, to the lesser extent, macrophages.) Thereafter, these complexes will undergo the metabolic mechanisms like extravascular hemolysis.Nevertheless, if the binding capacities of haptoglobin and hemopexin are saturated, the remaining "free hemoglobin" in the plasma will be oxidized to met-hemoglobin eventually, and then further disassociates into free heme and others. At this stage, the "free heme" will bind to albumin, forming met-hemalbumin. As to the remaining unbound (met)hemoglobin is filtered into the primary urine and re-absorbed via proximal tubules of the kidney. In proximal tubules, the iron is extracted and stored as hemosiderin. (Long-term hemoglobinuria is associated with substantial deposition of hemosiderin in proximal tubule (excessive accumulation of hemosiderin in proximal tubule), Fanconi syndrome (damaged renal re-absorption capability of small molecules which give rises to hyper-aminoaciduria, glycosuria, hyperphosphaturia, and bicarbonate and dehydration), and chronic kidney failure.)
Clindamycin/benzoyl peroxide is a topical gel used for the treatment of acne. It is a combination of clindamycin, an antibiotic, and benzoyl peroxide, an antiseptic.Common side effects include peeling, itching, and dryness of the skin where the gel was applied.Clindamycin/benzoyl peroxide was approved for medical use in the United States in December 2000. It is available as a generic medication. Medical uses
The gel is used on the skin to treat light to medium acne vulgaris in people 12 years and older. Efficacy
There is an average 52% decrease in inflammatory acne lesions by week 12.The combination is less effective than benzoyl peroxide/salicylic acid after short-term treatment of two to four weeks, but the two treatments showed similar effectiveness after ten to twelve weeks. Pregnancy and lactation
Studies on whether or not the use of clindamycin/benzoyl peroxide gels is teratogenic or has adverse effects on nursing infants have not been performed. While oral clindamycin passes into breast milk, no such data are available for clindamyin in gel form. Limited data regarding topical clindamycin and benzoyl peroxide have shown no safety problems. Contraindications
The gel is not recommended for those who are allergic to clindamycin, benzoyl peroxide, any components of the formulation, or lincomycin. Individuals previously diagnosed with regional enteritis, ulcerative colitis, or antibiotic-associated colitis are also recommended not to use it. Side effects
Common side effects are peeling, itching, redness, dryness, burning, and dermatitis. Benzoyl peroxide bleaches hair, clothes, towels, bedclothing, and the like.