Which of the following is NOT associated with intravascular hemolysis?

Methemoglobinemia is a condition characterized by an elevated level of methemoglobin in the blood, which is a form of hemoglobin that cannot effectively release oxygen to the tissues. While intravascular hemolysis is associated with the destruction of red blood cells within blood vessels, leading to the release of hemoglobin into the plasma, methemoglobinemia itself is typically associated with other conditions such as oxidative stress or exposure to certain drugs and chemicals.

Intravascular hemolysis triggers a series of responses within the body, notably leading to symptoms and laboratory findings such as hemoglobinuria, where free hemoglobin is excreted in urine due to it being overwhelmed by the kidneys after red blood cells are lysed and hemoglobin spills into circulation. Hemoglobinemia, the presence of free hemoglobin in the blood, is also a direct consequence of red blood cell destruction. Additionally, haptoglobin, a protein that binds free hemoglobin to facilitate its removal by the liver, is typically decreased during intravascular hemolysis because it gets depleted as it binds to the excess hemoglobin released from lysed cells.

Thus, methemoglobinemia, while a hematological condition, does not follow the typical patterns or consequences of