Hemolytic anemia

Email this page to a friendShare on facebook Share on twitter Bookmark & Share Printerfriendly version Hemolytic anemia is a condition in which there are not enough red blood cells in the blood, due to the premature destruction of red blood cells. There are a number of specific types of hemolytic anemia, which are described individually.

Causes
Hemolytic anemia occurs when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells. If the bone marrow is able to keep up with the early destruction, anemia does not occur (this is sometimes called compensated hemolysis). There are many types of hemolytic anemia, which are classified by the reason for the premature destruction of red blood cells. The defect may be in the red blood cell itself (intrinsic factors), or outside the red blood cell (extrinsic factors). Intrinsic factors are often present at birth (hereditary). They include:

Abnormalities in the proteins that build normal red blood cells Differences in the protein inside a red blood cell that carries oxygen (hemoglobin)

Extrinsic factors include:

Abnormal immune system responses Blood clots in small blood vessels Certain infections Side effects from medications

Types of hemolytic anemia include:

Hemoglobin SC disease (similar in symptoms to sickle-cell anemia) Hemolytic anemia due to G6PD deficiency Hereditary elliptocytosis Hereditary ovalocytosis Hereditary spherocytosis Idiopathic autoimmune hemolytic anemia Malaria Microangiopathic hemolytic anemia (MAHA) Non-immune hemolytic anemia caused by chemicals or toxins Paroxysmal nocturnal hemoglobinuria (PNH) Secondary immune hemolytic anemia Sickle-cell anemia Thalassemia Transfusion of blood from a donor with a different blood type

Symptoms

Chills Dark urine Enlarged spleen Fatigue Fever Pale skin color (pallor) Rapid heart rate Shortness of breath Yellow skin color (jaundice)

Exams and Tests

These are tests for red blood cell destruction (hemolysis). Specific tests can identify the types of hemolytic anemia. They are usually performed when hemolysis is suspected or has been determined.

Absolute reticulocyte count Free hemoglobin in the serum or urine Hemosiderin in the urine Red blood cell count (RBC), hemoglobin, and hematocrit (HCT) Serum haptoglobin levels Serum indirect bilirubin levels Serum LDH Urine and fecal urobilinogen

Directly measuring the red cell life span with radioactive tagging techniques shows a shortened life span. This disease may also affect the following test results, depending on the specific cause:

AST Coombs' test, direct Coombs' test, indirect Donath-Landsteiner test Febrile or cold agglutinins Leukocyte alkaline phosphatase Peripheral blood smear Platelet count Protein electrophoresis - serum RBC indices Serum creatinine Serum ferritin Serum iron Serum potassium level Serum uric acid TIBC White blood count differential

Treatment
Treatment depends on the type and cause of the hemolytic anemia. Folic acid, iron replacement, and corticosteroids may be used. In emergencies, a blood transfusion or removal of the spleen (splenectomy) may be necessary.

Outlook (Prognosis)
The outcome depends on the type and cause of hemolytic anemia.

Possible Complications
The complications depend on the specific type of hemolytic anemia. Severe anemia can cause cardiovascular collapse (failure of the heart and blood pressure, leading to death). Severe anemias can worsen heart disease, lung disease, or cerebrovascular disease.

Stroke
Email this page to a friendShare on facebook Share on twitter Bookmark & Share Printerfriendly version A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."

Causes
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

A clot may form in an artery that is already very narrow. This is called a thrombotic stroke. A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque

When to Contact a Medical Professional

Call for an appointment with your health care provider if you develop symptoms of hemolytic anemia.

Prevention
There is no known prevention for hemolytic anemia.

Alternative Names
Anemia - hemolytic

References
Schwartz RS. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 164. Powers A, Silberstein LE. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ, Shattil SS, et al, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone;2008:chap 47. Schrier SL, Price EA. Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ, Shattil SS, et al, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone;2008:chap 48.
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Hemolytic Anemia Complications

Complications of hemolytic anemia include:

Congestive heart failure Heart attack Angina

Seseorang dengan angina memiliki nyeri dada atau ketidaknyamanan dada, yang disebabkan oleh pengiriman oksigen rendah ke otot jantung. Dalam kebanyakan kasus, hal ini disebabkan oleh penyakit arteri koroner, penyempitan pembuluh darah yang memasok darah beroksigen ke jantung. Gejala-gejala angina terjadi ketika pasokan oksigen tidak dapat memenuhi permintaan. Angina tidak stabil menggambarkan gejala angina yang baru, memburuk, atau terjadi lebih sering.

Kidney failure Nutritional deficiencies Stroke

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Complications

Anaemia may lead to high-output cardiac failure. Jaundice creates problems associated with increased unconjugated bilirubin. In patients with intravascular haemolysis, iron deficiency due to chronic haemoglobinuria can exacerbate anaemia and weakness. Anemia dapat menyebabkan high-output gagal jantung. Penyakit kuning menciptakan masalah yang terkait dengan bilirubin tak terkonjugasi meningkat. Pada pasien dengan hemolisis intravaskular, kekurangan zat besi karena haemoglobinuria kronis dapat memperburuk anemia dan kelemahan.

Patient.co.uk

1. Clinical complications due to severe hemolytic anaemia - slowed growth and development in children - bilirubins stones - aplastic crisis - congestive heart failure from chronic anemias and cardiac overload compensation 2. Consequences of vaso-occlusion of the microcirculations (tissue ischemia and infarction) - infarction of spleen, brain, marrow, kidney, lung, aseptic necrosis, central nervous system and ophtalmic vascular lesions

1. Komplikasi klinis akibat anemia hemolitik berat - memperlambat pertumbuhan dan perkembangan pada anak - bilirubins batu - krisis aplastik - gagal jantung kongestif dari anemia kronis dan kompensasi kelebihan beban jantung 2. Konsekuensi vaso-oklusi dari microcirculations (jaringan iskemia dan infark) - infark limpa, pembuluh darah lesi otak, sumsum, ginjal, paru-paru, nekrosis aseptik, sistem saraf pusat dan ophtalmic