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Hemolytic anemia

Anemia - hemolytic

 

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Normally, red blood cells last for about 120 days in the body. In hemolytic anemia, red blood cells in the blood are destroyed earlier than normal.

Causes

 

The bone marrow is mostly responsible for making new red cells. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

Hemolytic anemia occurs when the bone marrow isn't making enough red cells to replace the ones that are being destroyed.

There are several possible causes of hemolytic anemia. Red blood cells may be destroyed due to:

  • An autoimmune problem in which the immune system mistakenly sees your own red blood cells as foreign substances and destroys them
  • Genetic defects within the red cells (such as sickle cell anemia, thalassemia, and G6PD deficiency)
  • Exposure to certain chemicals, drugs, and toxins
  • Infections
  • Blood clots in small blood vessels
  • Transfusion of blood from a donor with a blood type that does not match yours

 

Symptoms

 

You may not have symptoms if the anemia is mild. If the problem develops slowly, the first symptoms may be:

  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking

If the anemia gets worse, symptoms may include:

  • Lightheadedness when you stand up
  • Pale skin
  • Shortness of breath
  • Sore tongue
  • Enlarged spleen

 

Exams and Tests

 

A test called a complete blood count (CBC) can help diagnose anemia and offer some hints to the type and cause of the problem. Important parts of the CBC include red blood cell count (RBC), hemoglobin, and hematocrit (HCT).

These tests can identify the type of hemolytic anemia:

  • Absolute reticulocyte count
  • Coombs test, direct and indirect
  • Donath-Landsteiner test
  • Cold agglutinins
  • Free hemoglobin in the serum or urine
  • Hemosiderin in the urine
  • Platelet count
  • Protein electrophoresis - serum
  • Pyruvate kinase
  • Serum haptoglobin levels
  • Serum LDH

 

Treatment

 

Treatment depends on the type and cause of the hemolytic anemia:

  • In emergencies, a blood transfusion may be needed.
  • For an overactive immune system, drugs that suppress the immune system may be used.
  • When blood cells are being destroyed at a fast pace, the body may need extra folic acid and iron supplements to replace what is being lost.

In rare cases, surgery is needed to take out the spleen. This is because the spleen acts as a filter that removes abnormal cells from the blood.

 

Outlook (Prognosis)

 

Outcome depends on the type and cause of hemolytic anemia. Severe anemia can make heart disease, lung disease, or cerebrovascular disease worse.

 

When to Contact a Medical Professional

 

Call your health care provider if you develop symptoms of hemolytic anemia.

 

 

References

Gallegher PG. Hemolytic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 161.

Jager U, Lechner K. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 44.

Price EA, Schrier SS. Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 45.

 
  • Red blood cells, sickle cell

    Red blood cells, sickle cell - illustration

    Sickle cell anemia is an inherited blood disease in which the red blood cells produce abnormal pigment (hemoglobin). The abnormal hemoglobin causes deformity of the red blood cells into crescent or sickle-shapes, as seen in this photomicrograph.

    Red blood cells, sickle cell

    illustration

  • Red blood cells, multiple sickle cells

    Red blood cells, multiple sickle cells - illustration

    Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

    Red blood cells, multiple sickle cells

    illustration

  • Red blood cells, sickle cells

    Red blood cells, sickle cells - illustration

    These crescent or sickle-shaped red blood cells (RBCs) are present with Sickle cell anemia, and stand out clearly against the normal round RBCs. These abnormally shaped cells may become entangled and block blood flow in the small blood vessels (capillaries).

    Red blood cells, sickle cells

    illustration

  • Red blood cells, sickle and Pappenheimer

    Red blood cells, sickle and Pappenheimer - illustration

    This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

    Red blood cells, sickle and Pappenheimer

    illustration

  • Blood cells

    Blood cells - illustration

    Blood is comprised of red blood cells, platelets, and various white blood cells.

    Blood cells

    illustration

    • Red blood cells, sickle cell

      Red blood cells, sickle cell - illustration

      Sickle cell anemia is an inherited blood disease in which the red blood cells produce abnormal pigment (hemoglobin). The abnormal hemoglobin causes deformity of the red blood cells into crescent or sickle-shapes, as seen in this photomicrograph.

      Red blood cells, sickle cell

      illustration

    • Red blood cells, multiple sickle cells

      Red blood cells, multiple sickle cells - illustration

      Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

      Red blood cells, multiple sickle cells

      illustration

    • Red blood cells, sickle cells

      Red blood cells, sickle cells - illustration

      These crescent or sickle-shaped red blood cells (RBCs) are present with Sickle cell anemia, and stand out clearly against the normal round RBCs. These abnormally shaped cells may become entangled and block blood flow in the small blood vessels (capillaries).

      Red blood cells, sickle cells

      illustration

    • Red blood cells, sickle and Pappenheimer

      Red blood cells, sickle and Pappenheimer - illustration

      This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

      Red blood cells, sickle and Pappenheimer

      illustration

    • Blood cells

      Blood cells - illustration

      Blood is comprised of red blood cells, platelets, and various white blood cells.

      Blood cells

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Hemolytic anemia

         

         

        Review Date: 2/1/2016

        Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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