The hemolytic anemias are a category of diseases seen when red blood cells have a shortened life span and are broken down faster than they can be produced. This results in an anemia, a reduction in the total number of red blood cells.
Hemolytic anemia may be due to two general causes: an inherent defect in the red blood cell, as seen in sickle cell anemia, hereditary spherocytosis, and thalassemia, or a disorder outside of the red blood cell. Disorders outside the cell that may cause hemolytic anemia include the person's immune system inappropriately attacking his/her own red blood cells (autoimmune hemolytic anemia), an appropriate immune attack of mismatched red blood cells in a transfusion reaction, an adverse effect of a drug taken for another disease, or excessive trapping of blood cells in the spleen (hypersplenism).
Hemolytic anemia signs and symptoms
Shortness of breath.
Jaundice (yellow skin and eyes, dark urine).
Often the cause is unknown.
Inherited disorder, such as hereditary spherocytosis,
glucose-6-phosphate dehydrogenase (G6PD) deficiency,
sickle-cell anemia or thalassemia.
Favism (an acute hemolytic anemia caused by the
ingestion of the fava bean) is common in certain individuals,
primarily of Greek descent, due to a hereditary biochemical
Antibodies produced by the body to fight infections,
which for unknown reason attack red blood cells. This
response is sometimes triggered by blood transfusions.
Use of medications, including non-prescription drugs,
that damage red blood cells.
How is it diagnosed?
History will vary depending on how fast the hemolytic anemia develops. An individual with slow development may only report some yellowing of the skin and eyes (jaundice). Individuals with a faster onset of hemolytic anemia may have fatigue and shortness of breath. With an acute onset, there may be fever, chills, headache, and pain in the back, abdomen, or extremities. The urine may become red or dark. There is no history of abnormal blood loss with hemolytic anemia.
Physical exam findings include pallor, a fast heart rate, and heart murmur. Mild jaundice is usually present. The spleen and liver may be enlarged. Signs of heart failure can be seen with severe anemia.
Tests: A complete blood count (CBC) demonstrates the degree of anemia, and a blood smear will show an increased number of immature red blood cells (reticulocytes). Serum bilirubin will be elevated. The direct Coombs test will be positive in immune hemolytic anemias.
Risk increases with
Family history of hemolytic anemia.
Use of any medication.
Don't take any medicine that has previously triggered
Seek genetic counseling before having children if you
have a family history of hemolytic anemia (inherited
If hemolytic anemia is acquired, it can usually be cured
when the cause, such as a drug, is removed. Sometimes
it is necessary to remove the spleen surgically.
If secondary to an underlying disorder, the prognosis
is determined by the course of the primary disease.
If hemolytic anemia is inherited, it is currently considered
incurable. However, symptoms can be relieved or
Scientific research into causes and treatment continues,
so there is hope for increasingly effective treatment
Excessive spleen enlargement, which increases
destruction of red blood cells.
Pain, shock and serious illness caused by hemolysis
Hemolytic anemia treatment
Diagnostic tests will include laboratory blood studies.
Treatment is individualized depending on the specific
Some types may be preventable by avoidance of the
drugs or foods that precipitate hemolysis.
Surgical removal of the spleen may be recommended.
Immunosuppressive (e.g., prednisone) drugs to control the antibody response are usually prescribed.
Medication to reduce pain. For minor discomfort, you may use non-prescription drugs such as acetaminophen.
After treatment, resume normal activities as soon as possible.
Avoid cold temperatures.
No special diet.
Thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulopathy can initially resemble hemolytic anemia.
Notify your physician if
You or a family member has symptoms of hemolytic anemia.
The following occur during treatment:
Signs of infection in any part of the body (redness, pain, swelling, fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.