Hemolytic anemia (patient information)

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Overview
Hemolytic anemia is a condition in which there are not enough red blood cells in the blood, due to the premature destruction of red blood cells. There are a number of specific types of hemolytic anemia, which are described individually.

What are the symptoms of Hemolytic anemia?

 * Chills
 * Dark urine
 * Enlarged spleen
 * Fatigue
 * Fever
 * Pale skin color (pallor)
 * Rapid heart rate
 * Shortness of breath
 * Yellow skin color (jaundice)

What causes Hemolytic anemia?

 * Hemolytic anemia occurs when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells. If the bone marrow is able to keep up with the early destruction, anemia does not occur (this is sometimes called compensated hemolysis).


 * There are many types of hemolytic anemia, which are classified by the reason for the premature destruction of red blood cells. The defect may be in the red blood cell itself (intrinsic factors), or outside the red blood cell (extrinsic factors).


 * Intrinsic factors are often present at birth (hereditary). They include:
 * Abnormalities in the proteins that build normal red blood cells
 * Differences in the protein inside a red blood cell that carries oxygen (hemoglobin)


 * Extrinsic factors include:
 * Abnormal immune system responses
 * Blood clots in small blood vessels
 * Certain infections
 * Side effects from medications


 * Types of hemolytic anemia:
 * Secondary immune hemolytic anemia
 * Idiopathic autoimmune hemolytic anemia
 * Non-immune hemolytic anemia caused by chemicals or toxins
 * Microangiopathic hemolytic anemia (MAHA)
 * Sickle-cell anemia
 * Hemoglobin SC disease (similar in symptoms to sickle-cell anemia)
 * Thalassemia
 * Hemolytic anemia due to G6PD deficiency
 * Paroxysmal nocturnal hemoglobinuria (PNH)
 * Hereditary elliptocytosis
 * Hereditary ovalocytosis
 * Hereditary spherocytosis
 * Malaria
 * Transfusion of blood from a donor with a different blood type

When to seek urgent medical care?
Call for an appointment with your health care provider if you develop symptoms of hemolytic anemia.

Diagnosis

 * These are tests for red blood cell destruction (hemolysis). Specific tests can identify the types of hemolytic anemia. They are usually performed when hemolysis is suspected or has been determined.
 * Absolute reticulocyte count
 * Free hemoglobin in the serum or urine
 * Hemosiderin in the urine
 * Red blood cell count (RBC), hemoglobin, and hematocrit (HCT)
 * Serum haptoglobin levels
 * Serum indirect bilirubin levels
 * Serum LDH
 * Urine and fecal urobilinogen


 * Directly measuring the red cell life span with radioactive tagging techniques shows a shortened life span.


 * This disease may also affect the following test results, depending on the specific cause:
 * AST
 * Coombs' test, direct
 * Coombs' test, indirect
 * Donath-Landsteiner test
 * Febrile or cold agglutinins
 * Leukocyte alkaline phosphatase
 * Peripheral blood smear
 * Platelet count
 * Protein electrophoresis - serum
 * RBC indices
 * Serum creatinine
 * Serum ferritin
 * Serum iron
 * Serum potassium level
 * Serum uric acid
 * TIBC
 * White blood count differential

Treatment options
Treatment depends on the type and cause of the hemolytic anemia.
 * Folic acid, iron replacement, and corticosteroids may be used.
 * In emergencies, a blood transfusion or removal of the spleen (splenectomy) may be necessary.

Where to find medical care for Hemolytic anemia?
Directions to Hospitals Treating Hemolytic anemia

Prevention
There is no known prevention for hemolytic anemia.

What to expect (Outlook/Prognosis)?
The outcome depends on the type and cause of hemolytic anemia.

Possible complications
The complications depend on the specific type of hemolytic anemia.
 * Severe anemia can cause cardiovascular collapse (failure of the heart and blood pressure, leading to death).
 * Severe anemias can worsen heart disease, lung disease, or cerebrovascular disease.