Hemolytic Anemia

Anemia is a condition in which the body does not have enough healthy red blood cells to provide oxygen to body tissues. Normal red blood cells have a lifespan of about 120 days.

The signs and symptoms of hemolytic anemia will depend on the type and severity of the disease.

People who have mild hemolytic anemia often have no signs or symptoms. 

The most common symptom of all types of anemia is fatigue (tiredness).

More severe hemolytic anemia may cause many signs and symptoms, and may include:

• Pale skin and lips
• Jaundice (yellowing of the skin, eyes, and mouth)
• Dark-colored urine
• Fever
• Weakness
• Dizziness
• Mental Confusion
• Intolerance to physical activity
• Faster than normal heart rate

Many diseases, conditions, and factors can cause early destruction of red blood cells, including:

• Inherited (genetic) defects in red cells including sickle cell anemia, thalassemia, and G6PD deficiency
• The Immune system develops antibodies against red blood cells which causes them to break down prematurely.
• Exposure to certain chemicals
• Certain medicines can bind to red blood cell surfaces and can cause antibodies to develop. Other medicines cause hemolytic anemia in other ways.
• Infections (hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and others)
• Blood clots in small blood vessels
• Blood transfusion or medication-related reactions
• Enlarged spleen
• Tumors
• Leukemia
• Lymphoma
• Autoimmune disorders such as systemic lupus erythematous (SLE), rheumatoid arthritis, others

In addition to a complete physical examination, your doctor may order the following diagnostic tests:

• Blood tests to measure hemoglobin and reticulocyte count and to determine how many new red blood cells are being produced.
• Liver function tests 
• Tests to look for certain antibodies
• Urine tests for hemoglobin
• Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

If the cause of your hemolytic anemia can be found and treated (for example if you have an acquired form of the condition) your hemolytic anemia may go away. Inherited forms of hemolytic anemia may require ongoing treatment, possibly lifelong treatment.

In the case of ongoing treatment, it is important that you see your healthcare provider regularly. He or she may recommend you get annual flu and pneumonia vaccines to reduce the chances of getting those infections.

Certain lifestyle changes may be recommended depending on the type of hemolytic anemia you have.

If you have cold-reactive autoimmune hemolytic anemia, stay away from cold temperatures. During cold weather, wear a hat, scarf, and a warm coat. When taking cold food out of the refrigerator or freezer, wear gloves. Turn down air conditioning or dress warmly while in air-conditioned spaces. Warm up the car before driving in cold weather.

If you have glucose-6-phosphate dehydrogenase (G6PD) deficiency, avoid substances that can trigger anemia. For example, avoid fava beans, naphthalene (a substance found in some moth balls), and certain medicines (as your doctor advises).

Ask your doctor what types and amounts of physical activity are safe for you. You may want to avoid certain sports or activities that could worsen your condition or lead to complications.

Specific treatment for hemolytic anemia will be determined by your doctor based on a variety of factors including:

• Your age
• Your medical history
• The extent and cause of the disease

Treatment for hemolytic anemia may include:

• Blood transfusions
• Corticosteroid medications
• Treatment with intravenous immune globulin (to strengthen the immune system)
• Rituximab

The following treatments may be necessary for more severe cases. These treatments may require hospitalization:

• Exchange transfusion (similar to a blood transfusion but with more blood being given and an equal amount of hemolyzed blood being removed)
• Surgical removal of the spleen
• Immunosuppressive therapy

For severe cases of hypersplenism, it may be necessary to remove the spleen.

If there is physical damage to red blood cells treatment with folic acid and iron supplements may be required. Blood transfusions may be necessary.

The prognosis for hemolytic anemia depends on its cause and severity and the underlying health of the affected individual.

Hemolytic anemia caused by medication use or infections usually go away quickly.

People with autoimmune hemolytic anemia usually respond well to treatment.

The outlook for people with inherited hemolytic anemias depends on the type of inherited illness and its severity.