Red blood cells have the important mission of carrying oxygen
from your lungs to your heart and throughout your entire body. Your bone marrow
is responsible for making these red blood cells. When dying red blood cells
outpace the bone marrow’s production in a person, hemolytic anemia occurs. Hemolytic
anemia can be extrinsic or intrinsic.
anemia is also known as autoimmune hemolytic anemia. This type of anemia develops
when the spleen traps and destroys healthy red blood cells. It can also come
from red blood cell destruction due to:
- autoimmune disorders
- medication side effects
anemia develops when the red blood cells produced by your body are
defective. This condition is often inherited, such as in people with sickle
cell anemia or thalassemia.
Anyone of any age can develop hemolytic anemia. However,
according to the National
Heart, Lung, and Blood Institute (NHLBI), hemolytic anemia seems to affect
more African Americans than Caucasians. This is likely because sickle cell
anemia is more prevalent amongst African Americans.
Causes of Hemolytic Anemia
While it’s possible that a doctor may not be able to
pinpoint the source of hemolytic anemia, there are several diseases and even
medications that can cause this condition. The following are some underlying
causes of extrinsic hemolytic anemia:
- enlarged spleen
- Epstein-Barr virus
- typhoid fever
- Wiskott-Aldrich syndrome, an autoimmune disorder
- HELLP syndrome (named for its characteristics,
which include hemolysis, elevated liver enzymes, and low platelet count)
Hemolytic anemia isn’t always due to an autoimmune disorder.
In some instances, it’s the result of taking certain medications. This is known
as drug-induced hemolytic anemia. Some examples of medicines that could cause
the condition are:
- antibiotics, such as penicillin, ampicillin, or
- chlorpromazine (Thorazine)
- interferon alfa
- rifampin (Rifadin)
One of the most severe forms of hemolytic anemia is the kind
caused by receiving a blood transfusion of the wrong blood type. Every person
has a distinct blood type (A, B, AB, or O). If you receive the incorrect blood
type, your existing blood will begin to produce immune cells called antibodies
to fight the transfused blood. The result is an extremely fast destruction of
red blood cells. This is why healthcare providers need to carefully check blood
types before giving blood.
Some causes of hemolytic anemia are temporary. Hemolytic
anemia is curable if a doctor can identify the underlying cause and treats it.
What Are the Symptoms of Hemolytic Anemia?
Because there are so many different causes of hemolytic
anemia, each person can have different symptoms. However, there are some shared
symptoms that many people experience when they have hemolytic anemia.
Some symptoms of hemolytic anemia are the same as other
forms of anemia.
These common symptoms include:
- paleness of the skin
- weakness or inability to do physical activity
Other less common signs and symptoms that are seen in
patients with hemolytic anemia include:
- dark urine
- yellowing of the skin and the whites of the eyes
- heart murmur
- increased heart rate
- enlarged spleen
- enlarged liver
Hemolytic Anemia in Newborns
Hemolytic disease of the newborn is a condition that occurs
when a mother and baby have incompatible blood types. Another name for this
condition is erythroblastosis fetalis. With blood types, a person can be either
an Rh negative or an Rh positive. Some examples include A positive, A negative,
AB negative, O positive, and other variations on these blood types.
If a mother has a negative blood type and her baby’s father
has a positive one, there’s a chance hemolytic disease of the newborn can
occur. The effects of this are just like blood transfusion reactions. The
mother’s body sees the baby’s blood type as “foreign” and could potentially
attack the baby.
This condition is more likely to happen to a woman in her
second pregnancy. This is due to how the body builds its immunity. In her first
pregnancy, a mother’s immune system learns how to develop defenses against the negative
blood cells. Doctors call this being sensitized to the different type of blood
Hemolytic disease of the newborn is a problem because the
baby can become anemic, which causes further complications. Treatments are
available for this condition. They include blood transfusions and medications
known as intravenous immunoglobulin (IVIG).
Doctors can also prevent the condition from happening by
giving a woman an injection known as a RhoGAM shot. A woman may receive this
shot around her 28th week of pregnancy if she has Rh negative blood.
Hemolytic Anemia in Children
According to the University
of Chicago, hemolytic anemia in children usually occurs after a viral
illness. The causes are similar to those found in adults and include:
- autoimmune diseases
- a rare syndrome known as Evans syndrome
Diagnosing Hemolytic Anemia
Diagnosing hemolytic anemia often begins with a review of your
medical history and symptoms. During the physical exam, your doctor will be
checking for pale or yellowed skin, and they may also press gently on different
areas of your stomach to check for tenderness, which could indicate an enlarged
liver or spleen.
If a doctor suspects anemia, they’ll order diagnostic tests.
Blood tests that help to diagnose hemolytic anemia include:
- bilirubin, which is a test that measures the
level of red blood cells your liver has broken down
- hemoglobin, which is a test that measures the
amount of red blood cells you have
- liver function tests
- reticulocyte count, which is a test that
measures how many red blood cells your body is producing
If your doctor thinks your condition may be related to
intrinsic anemia, they may have your blood samples viewed under a microscope to
examine their shape and size.
Other tests include a urine test to look for the presence of
red blood cells. In some cases, a doctor may order a bone marrow aspiration or
biopsy. This test can provide information about how many red blood cells are
being made and their shape.
How Is Hemolytic Anemia Treated?
Treatment options for hemolytic anemia differ depending on
severity of the condition, your age, your health, and your tolerance to certain
Treatment options for hemolytic anemia include:
- blood transfusion
- intravenous immunoglobulin
- corticosteroid medication
A blood transfusion is given to quickly increase your red
blood cell count and to replace destroyed red blood cells with new ones.
Intravenous Immunoglobulin (IVIG)
A low blood cell count can negatively affect the way your
immune system fights infection. You may be given immunoglobulin intravenously in the hospital to improve your
immune system function.
In the case of an extrinsic form of hemolytic anemia of
autoimmune origin, corticosteroids are used to stop your immune system from
making antibodies that destroy red blood cells.
In severe cases, your spleen may
need to be removed. The spleen is where red blood cells are destroyed. Removing
the spleen can reduce how fast red blood cells are destroyed. However, this is
usually used as an option only after all other treatments have been used.
Hemolytic anemia can
affect people of all ages and has numerous underlying causes. For some people,
symptoms are mild and resolve with time and without treatment. Others may need
care for the rest of their lives. Seeking care when a person has early anemia
symptoms can be the first step to feeling better in the long term.