Hemolytic anemia occurs when red blood cells are destroyed faster than your bone marrow can make them. This can be caused by diseases, autoimmune disorders, or cancer. The treatment depends on the cause.
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.
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:
- autoimmune disorders
- medication side effects
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, who have abnormal hemoglobin.
Other times, an inherited metabolic abnormality can lead to this condition, such as in people with G6PD deficiency, or red blood cell membrane instability, such as hereditary spherocytosis.
Anyone of any age can develop hemolytic anemia.
It’s possible that a doctor may not be able to pinpoint the source of hemolytic anemia. However, several diseases, and even some medications, can cause this condition.
Underlying causes of extrinsic hemolytic anemia include:
- enlarged spleen
- infectious hepatitis
- Epstein-Barr virus
- typhoid fever
- E. coli toxin
- systemic lupus erythematosus (SLE), an autoimmune disorder
- Wiskott-Aldrich syndrome, an autoimmune disorder
- HELLP syndrome (named for its characteristics, which include hemolysis, elevated liver enzymes, and low platelet count)
In some instances, hemolytic anemia is 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 cephalexin, ceftriaxone, penicillin, ampicillin, or methicillin
- chlorpromazine (Thorazine)
- ibuprofen (Advil, Motrin IB)
- interferon alpha
- rifampin (Rifadin)
One of the most severe forms of hemolytic anemia is the kind caused by receiving a red blood cell 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 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, usually because of Rh incompatibility. Another name for this condition is erythroblastosis fetalis.
In addition to the ABO blood types (A, B, AB, and O) discussed earlier, Rh factor also figures in a person’s specific blood type: A person can be either negative or positive for Rh factor. Some examples include A positive, A negative, AB negative, and O positive.
If a mother has a negative Rh blood type and her baby’s father has a positive one, there’s a chance hemolytic disease of the newborn can occur if the baby’s red blood cells are then positive for Rh factor.
The effects of this are just like red blood cell transfusion reactions where there is an ABO mismatch. 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 and thereafter. 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 red blood cells it sees as foreign. Doctors call this being sensitized to the different type of red blood cells.
Hemolytic disease of the newborn is a problem because the baby can become significantly anemic, which causes further complications. Treatments are available for this condition. They include red blood cell 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, if she has Rh-negative blood and has not been sensitized to an Rh-positive fetus. If the baby is Rh positive, then at 72 hours after delivery, the Rh-negative mother will need a second dose of RhoGam.
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 abdomen to check for tenderness, which could indicate an enlarged liver or spleen.
If a doctor suspects anemia, they’ll order diagnostic tests. These blood tests help to diagnose hemolytic anemia by measuring your:
- Bilirubin. This test measures the level of red blood cell hemoglobin that your liver has broken down and processed.
- Hemoglobin. This test indirectly reflects the amount of red blood cells you have circulating in your blood (by measuring the oxygen-carrying protein within your red blood cells)
- Liver function. This test measures the levels of proteins, liver enzymes, and bilirubin in your blood.
- Reticulocyte count. This test measures how many immature red blood cells, which over time mature into red blood cells, that your body is producing
If your doctor thinks your condition may be related to an intrinsic hemolytic 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 cell breakdown. 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:
- red blood cell transfusion
immunosuppressants, such as a corticosteroid
Red blood cell transfusion
A red blood cell 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.
In the case of an extrinsic form of hemolytic anemia of autoimmune origin, you may be prescribed corticosteroids. They can reduce your immune system activity to help prevent red blood cells from being destroyed. Other immunosuppressants may be used to achieve the same goal.
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 or other 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.