When destruction of red blood cells outpaces a person’s bone marrow production of these cells, hemolytic anemia occurs.
Hemolytic anemia can be extrinsic or intrinsic.
Extrinsic hemolytic anemia develops by several methods, such as when the spleen traps and destroys healthy red blood cells or an autoimmune reaction occurs. It can also come from red blood cell destruction due to:
Intrinsic hemolytic anemia develops when the red blood cells produced by your body don’t function properly. This condition is often inherited, such as in people with sickle cell anemia or thalassemia. Other times, a metabolic abnormality, such as in people with G6PD deficiency, or red blood cell membrane instability can lead to the condition.
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 among African-Americans.
It’s possible that a doctor may not be able to pinpoint the source of hemolytic anemia. However, 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
- E. coli toxin
- 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 medications that could cause the condition are:
- acetaminophen (Tylenol)
- antibiotics, such as penicillin, ampicillin, or methicillin
- chlorpromazine (Thorazine)
- ibuprofen (Advil, Motrin IB)
- 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 an incompatible blood type, specialized immune proteins called antibodies will attack the foreign red blood cells. The result is an extremely fast destruction of red blood cells, which can be lethal. This is why healthcare providers need to carefully check blood types before giving blood.
Some causes of hemolytic anemia are temporary. Hemolytic anemia may be curable if a doctor can identify the underlying cause and treat it.
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 those for 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 those with hemolytic anemia include:
- dark urine
- yellowing of the skin and the whites of the eyes (jaundice)
- heart murmur
- increased heart rate
- enlarged spleen
- enlarged liver
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.
In addition to the blood types A, B, AB, and O discussed earlier, Rh factor figures in a person’s specific blood type: This factor can be either negative or positive. Some examples include A positive, A negative, AB negative, and O positive.
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 cells.
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 a medication 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, and several times after, if she has Rh-negative blood.
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 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. 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.
Treatment options for hemolytic anemia differ depending on the reason for anemia, severity of the condition, your age, your health, and your tolerance to certain medications.
Treatment options for hemolytic anemia may include:
A blood transfusion is given to quickly increase your red blood cell count and to replace destroyed red blood cells with new ones.
You may be given immunoglobulin intravenously in the hospital to blunt the body’s immune system if an immune process is leading to hemolytic anemia. Immunosuppressants may be used to achieve the same goal.
In the case of an extrinsic form of hemolytic anemia of autoimmune origin, you may be prescribed corticosteroids. They can 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. This is usually used as an option in cases of immune hemolysis that don’t respond to corticosteroids and immunosuppressants.
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.