Hemolytic Anemia

What is hemolytic anemia?
Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than the bone marrow can produce them. The term for destruction of red blood cells is hemolysis. There are two types of hemolytic anemia, including the following:

intrinsic - the destruction of the red blood cells due to a defect within the red blood cells themselves. Intrinsic hemolytic anemias are often inherited, such as sickle cell anemia and thalassemia. These conditions produce red blood cells that do not live as long as normal red blood cells.
extrinsic - red blood cells are produced healthy but are later destroyed by becoming trapped in the spleen, destroyed by infection, or destroyed from drugs that can affect red blood cells. The following lists some of the causes of extrinsic hemolytic anemia, also called autoimmune hemolytic anemia:
- infections, such as hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), typhoid fever, E. coli (escherichia coli), or streptococcus
- medications, such as penicillin, antimalaria medications, sulfa medications, or acetaminophen
- leukemia or lymphoma
- autoimmune disorders, such as systemic lupus erythematous (SLE, or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
- various tumors

Some types of extrinsic hemolytic anemia are temporary and resolve over several months. Other types can become chronic with periods of remissions and recurrence.

What are the symptoms of hemolytic anemia?

The following are the most common symptoms of hemolytic anemia. However, each individual may experience symptoms differently. Symptoms may include:

abnormal paleness or lack of color of the skin
jaundice, or yellowing of the skin, eyes, and mouth
dark color to urine
fever
weakness
dizziness
confusion
intolerance to physical activity
enlargement of the spleen and liver
increased heart rate (tachycardia)
heart murmur

The symptoms of hemolytic anemia may resemble other blood conditions or medical problems. Always consult your physician for a diagnosis.

How is hemolytic anemia diagnosed?

Hemolytic anemia may be suspected from general findings on a complete medical history and physical examination, such as complaints of tiring easily, pale skin and lips, or a fast heartbeat (tachycardia). In addition to a complete physical examination, your physician may order the following diagnostic tests:

blood tests (to measure hemoglobin and reticulocyte count; test that reveals how many new red blood cells are being produced)
additional blood tests (to check liver function as well as the presence of certain antibodies)
urine tests
bone marrow aspiration and/or biopsy - a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

Treatment for hemolytic anemia:

Specific treatment for hemolytic anemia will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
cause of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

The treatment for hemolytic anemia will vary depending on the cause of the illness. Treatment may include:

blood transfusions
corticosteroid medications
treatment with intravenous immune globulin (to strengthen the immune system)

In more severe cases, the following treatments may be necessary and usually require hospitalization:

exchange transfusion (similar to a blood transfusion but with more blood being given and an equal amount of hemolyzed blood being removed)
surgical removal of the spleen
immunosuppressive therapy

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