Your bone marrow is responsible for producing red blood cells, white blood cells, and platelets (cells responsible for clotting). Hemolytic anemia is a condition that involves only the red blood cells. When old red blood cells die, the bone marrow produces new ones to maintain balance. Hemolytic anemia occurs when red blood cells die sooner than the bone marrow can produce them. The scientific term for red blood cell destruction is hemolysis. There are two forms of hemolytic anemia: intrinsic and extrinsic.
Extrinsic hemolytic anemia develops when the spleen traps and destroys healthy red blood cells. It can also come from red blood cell destruction due to infection, tumors, autoimmune disorders, medication side effects, leukemia, or lymphoma. Intrinsic hemolytic anemia develops when the red blood cells produced by the body are defective. The 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, hemolytic anemia seems to affect more African-Americans than Caucasians (NHLBI). This is likely because sickle cell anemia is more prevalent amongst African-Americans.
The cause of hemolytic anemia is red blood cell destruction. Red blood cell destruction can arise from blood disorders, toxins, or infection.
Among others, underlying causes of of hemolytic anemia include:
- Epstein-Barr Virus (EBV)
- typhoid fever
- sickle cell anemia
- E. coli
- pain medication
- Wiscott Aldridge syndrome
Some cases of anemia have no known cause.
Some symptoms of hemolytic anemia are the same as other forms of anemia.
These common symptoms include:
- paleness of the skin
- weakness/inability to do physical activity
Other, less common signs and symptoms seen in patients 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
After going over your medical history and discussing any symptoms you are experiencing, your doctor may suspect anemia. Your doctor may ask you to lie flat on your back while he or she presses gently on various areas of your abdomen. This physical examination can reveal tenderness in the abdomen as well as a swollen liver.
To confirm the diagnosis, your doctor will give you a blood test. This test measures the levels of your hemoglobin and reticulocyte (very young red blood cells made by the bone marrow in response to anemia). The reticulocyte count measures how many red blood cells your body is producing. Your doctor can use additional tests to check for other illnesses, the presence of bacteria, or different types of anemia. Because hemolytic anemia can be caused by liver disease and result in an enlarged liver, your doctor can also use a blood test to see how your liver is functioning.
If necessary, your doctor may take a small amount of fluid from your bone marrow. This test is a minimally invasive procedure and is called a bone marrow aspiration or biopsy. Your doctor will give you a local anesthetic to prevent pain. He or she will then insert a needle into your bone, usually at an area near the posterior or back of the hip or the posterior iliac crest, and withdraw marrow from the bone. The sample is sent to the lab, where a technician will look at it to determine what types and amounts of cells are being produced. At the lab, the cells will also be checked for any abnormalities.
Treatment options for hemolytic anemia differ depending on severity of the condition, your age, your health, and your tolerance to certain medications.
Treatment options for hemolytic anemia include:
- blood transfusion
- intravenous immune globulin
- 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 Immune Globulin
A low blood cell count can negatively affect the way your immune system fights infection. You may be given immune globulin through an IV 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.
Some people have hemolytic anemia that’s reactive to cold. If you have this condition, stay warm as much as possible to reduce symptoms.
Inherited forms of hemolytic anemia are addressed differently than acute (short-term) forms of the condition. Your doctor may approach treatment differently if you have an inherited form of hemolytic anemia.
Written by: April Kahn
Medically reviewed by Brenda B. Spriggs, MD, MPH, FACP