Hemolytic Anemia: What It Is and How

to Treat It

Causes

Symptoms

In newborns

In children

Diagnosis

Treatment

Outlook

Hemolytic anemia
Red blood cells have the important mission of carrying oxygen from
your lungs to your heart and throughout your entire body. Your bone
marrow is responsible for making these red blood cells. When dying
red blood cells outpace the bone marrows production in a person,
hemolytic anemia occurs. Hemolytic anemia can be extrinsic or
intrinsic.

Extrinsic hemolytic anemia is also known as autoimmune hemolytic

anemia. This type of anemia develops when the spleen traps and
destroys healthy red blood cells. It can also come from red blood cell
destruction due to:

infection
tumors
autoimmune disorders
medication side effects
leukemia
lymphoma
Intrinsic hemolytic anemia develops when the red blood cells produced
by your body are defective. This condition is often inherited, such as in
people with sickle cell anemia or thalassemia.

Anyone of any age can develop hemolytic anemia. However, according

to the National Heart, Lung, and Blood Institute (NHLBI), hemolytic
anemia seems to affect more African-Americans than Caucasians. This
is likely because sickle cell anemia is more prevalent amongst African-
Americans.

CAUSES

Causes of hemolytic anemia

Its possible that a doctor may not be able to pinpoint the source of
hemolytic anemia. However, there are several diseases and even
medications that can cause this condition. The following are some
underlying causes of extrinsic hemolytic anemia:
 enlarged spleen
hepatitis
Epstein-Barr virus
typhoid fever
Escherichia coli
streptococcus
leukemia
lymphoma
tumors
lupus
Wiskott-Aldrich syndrome, an autoimmune disorder
HELLP syndrome (named for its characteristics, which include
hemolysis, elevated liver enzymes, and low platelet count)
Hemolytic anemia isnt always due to an autoimmune disorder. In some
instances, its the result of taking certain medications. This is known as
drug-induced hemolytic anemia. Some examples of medications that
could cause the condition are:

acetaminophen
antibiotics, such as penicillin, ampicillin, or methicillin
chlorpromazine (Thorazine)
ibuprofen
interferon alfa
procainamide
quinine
rifampin (Rifadin)
One of the most severe forms of hemolytic anemia is the kind caused
by receiving a blood transfusion of the wrong blood type. Every person
has a distinct blood type (A, B, AB, or O). If you receive an incompatible
blood type, your existing blood will begin to produce immune cells
called antibodies to fight the transfused blood. The result is an
extremely fast destruction of red blood cells. This is why healthcare
providers need to carefully check blood types before giving blood.

Some causes of hemolytic anemia are temporary. Hemolytic anemia is

curable if a doctor can identify the underlying cause and treat it.

SYMPTOMS

What are the symptoms of hemolytic anemia?

Because there are so many different causes of hemolytic anemia, each
person can have different symptoms. However, there are some shared
symptoms that many people experience when they have hemolytic
anemia.

Some symptoms of hemolytic anemia are the same as other forms of

anemia.

These common symptoms include:

paleness of the skin

fatigue
fever
confusion
lightheadedness
dizziness
weakness or inability to do physical activity
Other less common signs and symptoms that are seen in those with
hemolytic anemia include:

dark urine
yellowing of the skin and the whites of the eyes (jaundice)
heart murmur
increased heart rate
enlarged spleen
 enlarged liver
AD V ER T IS E M E N T

IN NEWBORNS

Hemolytic anemia in newborns

Hemolytic disease of the newborn is a condition that occurs when a
mother and baby have incompatible blood types. Another name for
this condition is erythroblastosis fetalis. With blood types, a person can
be either an Rh negative or an Rh positive. Some examples include A
positive, A negative, AB negative, O positive, and other variations on
these blood types.

If a mother has a negative blood type and her babys father has a
positive one, theres a chance hemolytic disease of the newborn can
occur. The effects of this are just like blood transfusion reactions. The
mothers body sees the babys blood type as foreign and could
potentially attack the baby.

This condition is more likely to happen to a woman in her second

pregnancy. This is due to how the body builds its immunity. In her first
pregnancy, a mothers immune system learns how to develop defenses
against the negative blood cells. Doctors call this being sensitized to
the different type of blood cells.

Hemolytic disease of the newborn is a problem because the baby can

become anemic, which causes further complications. Treatments are
available for this condition. They include blood transfusions and
medications known as intravenous immunoglobulin (IVIG).

Doctors can also prevent the condition from happening by giving a

woman an injection known as a RhoGAM shot. A woman may receive
this shot around her 28th week of pregnancy if she has Rh negative
blood.

IN CHILDREN

Hemolytic anemia in children

According to the University of Chicago, hemolytic anemia in children
usually occurs after a viral illness. The causes are similar to those found
in adults and include:

infections
autoimmune diseases
cancers
medications
a rare syndrome known as Evans syndrome
DIAGNOSIS

Diagnosing hemolytic anemia

Diagnosing hemolytic anemia often begins with a review of your
medical history and symptoms. During the physical exam, your doctor
will be checking for pale or yellowed skin. They may also press gently
on different areas of your stomach to check for tenderness, which
could indicate an enlarged liver or spleen.

If a doctor suspects anemia, theyll order diagnostic tests. Blood tests

that help to diagnose hemolytic anemia include:

bilirubin, which is a test that measures the level of red blood cells
your liver has broken down
hemoglobin, which is a test that measures the amount of red
blood cells you have
liver function tests
reticulocyte count, which is a test that measures how many red
blood cells your body is producing
If your doctor thinks your condition may be related to intrinsic anemia,
they may have your blood samples viewed under a microscope to
examine their shape and size.

Other tests include a urine test to look for the presence of red blood
cells. In some cases, a doctor may order a bone marrow aspiration or
biopsy. This test can provide information about how many red blood
cells are being made and their shape.

AD V ER T IS E M E N T

TREATMENT

How is hemolytic anemia treated?

Treatment options for hemolytic anemia differ depending on severity
of the condition, your age, your health, and your tolerance to certain
medications.

Treatment options for hemolytic anemia include:

blood transfusion
intravenous immunoglobulin
corticosteroid medication
surgery
Blood transfusion

A blood transfusion is given to quickly increase your red blood cell

count and to replace destroyed red blood cells with new ones.

Intravenous immunoglobulin (IVIG)

A low blood cell count can negatively affect the way your immune
system fights infection. You may be given immunoglobulin
intravenously in the hospital to improve your immune system function.

Corticosteroids

In the case of an extrinsic form of hemolytic anemia of autoimmune

origin, you may be prescribed corticosteroids. They can stop your
immune system from making antibodies that destroy red blood cells.

Surgery
In severe cases, your spleen may need to be removed. The spleen is
where red blood cells are destroyed. Removing the spleen can reduce
how fast red blood cells are destroyed. However, this is usually used as
an option only after all other treatments have been used.

Background
Hemolysis is the premature destruction of erythrocytes. A hemolytic
anemia will develop if bone marrow activity cannot compensate for the
erythrocyte loss. The severity of the anemia depends on whether the
onset of hemolysis is gradual or abrupt and on the extent of
erythrocyte destruction. Mild hemolysis can be asymptomatic while the
anemia in severe hemolysis can be life threatening and cause angina
and cardiopulmonary decompensation.
The clinical presentation also reflects the underlying cause for
hemolysis. For example, sickle cell anemia (see the image below) is
associated with painful occlusive crises. (See Presentation.)

Peripheral blood smear

with sickled cells at 1000X magnification. Image courtesy of Ulrich
Woermann, MD.
View Media Gallery

Hemolytic anemia has multiple causes, and the clinical presentation

can differ depending on the etiology. An array of laboratory tests are
available for detecting hemolysis, and specialized tests may be
indicated to diagnose the cause for hemolysis (see Workup). There are
differences in the management of various types of hemolytic anemias
(see Treatment).