It is an abnormally low level of red blood cells. Hemolytic anemia occurs when red blood cells are destroyed too quickly.
Red blood cells contain hemoglobin. Hemoglobin is a protein that carries oxygen in the blood.
Red blood cells are produced in the bone marrow and then released into the bloodstream. Normally, they live from 110 to 120 days. Old red blood cells are removed from the blood by the spleen and liver.
In people with hemolytic anemia, red blood cells have an abnormally short lifespan. There may be something wrong with them, or they are normal but they are destroyed by an external process.
Many different problems can cause hemolytic anemia. These include:
Hereditary abnormalities in the membranes of red blood cells : a red blood cell is like a small balloon filled with fluid.
The balloon is the membrane that contains the fluid inside it. Defects in the membrane can cause the cells to change shape. The abnormally shaped red blood cells are identified by the spleen as abnormal and destroyed.
Enzymatic deficiencies inherited within red blood cells. Enzymes are proteins and certain abnormal levels of enzymes cause red blood cells to become brittle. They are prone to being destroyed too fast.
Hemoglobin disorders : hemoglobins are proteins that carry oxygen. Some people inherit a gene that produces an abnormal type of hemoglobin.
Hemoglobin disorders include sickle cell anemia and thalassemias. Hemoglobin disorders can cause the easy destruction of red blood cells.
Physical damage to red blood cells : hemolytic anemia can occur when red blood cells are damaged:
- During heart-lung surgery.
- As they flow close to devices placed inside the body, especially artificial heart valves.
- If they are exposed to extreme heat, as in a patient with severe burns.
- Autoimmune hemolytic anemia: this occurs when the body’s immune system mistakenly destroys its own red blood cells.
Autoimmune hemolytic anemia can be caused by:
- Autoimmune diseases such as lupus .
- Certain types of infections.
- Certain medications
Hypersplenism : occurs when the spleen is enlarged and hyperactive. It traps circulating red blood cells and destroys them before they are old.
In some cases, it does not have a clear cause.
The symptoms vary widely. Mild cases may not cause any symptoms. The condition can only be discovered during a routine blood test.
In other people, obvious symptoms of anemia may develop. These include:
- Pale skin.
- Short of breath.
- Yellowing of the skin and eyes.
- Dark colored urine.
Your doctor will review your medical history. He or she will ask you to describe your symptoms.
Other questions may include:
- Do you have close relatives with a hereditary form of anemia?
- What medications do you take?
- Have you recently had a serious infection?
- Do you have an artificial heart valve?
- Do you have a synthetic graft in your blood vessels?
- Do you have any other medical problems, particularly autoimmune diseases?
During your physical examination, your doctor will look for signs of anemia. These include:
- Pale skin and nails.
- Fast pulse
- Heart murmur
- Enlargement of the spleen and liver.
This test will be followed by blood tests to:
- Measure the levels of red blood cells.
- Look at the size and shape of red blood cells.
- Measure the hemoglobin level.
- Determine the number of immature red blood cells. The marrow can shed immature blood cells in an effort to compensate for the anemia.
Your doctor may order tests to check for the presence of blood in the stool. This identifies the anemia that results from the loss of blood. Other blood tests verify anemia resulting from a lack of iron or certain vitamins in your diet.
Other tests will depend on the suspected cause of your hemolytic anemia.
The duration of hemolytic anemia depends on its cause.
Hemolytic anemia caused by a medication or infection is usually temporary. It disappears when the medication is stopped or the infection is treated.
Hemolytic anemia caused by a hereditary disease is a lifelong condition. The impact on a person’s quality of life and life can vary a lot.
It depends on the specific hereditary disorder and its severity. Some people do not have any symptoms. Others have severe and persistent symptoms.
Hemolytic anemia caused by medications can be prevented. Avoid the medication that is causing the problem.
There is no way to prevent hereditary hemolytic anemia. If a family inherits a hereditary anemia, it can undergo genetic tests. This can evaluate your chances of passing it on to your children.
The treatment for hemolytic anemia depends on its cause and severity.
Inherited abnormalities in the membranes of red blood cells: if hemoglobin levels are adequate, you may not need treatment. If hemoglobin levels fall too low, a blood transfusion may be necessary. In rare cases, the spleen is removed.
Enzymatic deficiencies inherited within red blood cells: blood transfusions are necessary to treat severe symptoms.
Hemoglobin disorders : treatment is not necessary if the disease is mild or does not cause any symptoms.
People with more severe forms of thalassemia require repeated blood transfusions. Some may be candidates for a bone marrow transplant.
Sickle-cell anemia can be treated with:
- Folic acid supplements.
- Blood transfusions.
- A medicine called hydroxyurea (Hydrea).
Physical damage to red blood cells: can be treated with folic acid and iron supplements. Blood transfusions may be necessary.
An autoimmune response: treatment depends on the cause and severity. If a medication or infection is causing the anemia, it may be enough to stop the medication or recover from the infection.
For more severe cases, treatment may include:
- Medication with corticosteroids.
- Intravenous infusions of immunoglobulin.
- Immunosuppressive drugs.
- Spleen removal
Hypersplenism : for severe symptoms, the spleen is removed.
People with severe chronic hemolytic anemia, especially those with sickle cell anemia or thalassemia, may require multiple blood transfusions. The iron in hemoglobin can accumulate in the body, causing iron overload and organ damage.
Drugs called iron chelators, which bind iron and improve iron removal from the body, help prevent organ damage due to iron overload.
When to call a professional
Call your doctor immediately if you develop symptoms of anemia. Also call if you notice a yellowish tone on your skin or the whites of your eyes.
If your family has an inherited form of anemia, you may want to consider genetic testing before starting a family.
The prospects for hemolytic anemia depend on its cause and severity. The underlying health of the affected person also affects the prognosis.
Cases that are caused by medications or infections usually disappear quickly.
People with autoimmune hemolytic anemia generally respond well to treatment.
The prognosis for people with inherited hemolytic anemias depends on the type of inherited disease and its severity.