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. When dying red blood cells outpace the bone marrow’s production in a person, hemolytic anemia occurs. Hemolytic anemia can be extrinsic or intrinsic.
Extrinsic hemolytic anemia is also known as autoimmune hemolytic anemia. This type of anemia develops when the spleen traps and destroys healthy red blood cells. 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 are defective. This 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 (NHLBI), hemolytic anemia seems to affect more African Americans than Caucasians. This is likely because sickle cell anemia is more prevalent amongst African Americans.
While it’s possible that a doctor may not be able to pinpoint the source of hemolytic anemia, 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
- Escherichia coli
- 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 medicines that could cause the condition are:
- antibiotics, such as penicillin, ampicillin, or methicillin
- chlorpromazine (Thorazine)
- 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 the incorrect blood type, your existing blood will begin to produce immune cells called antibodies to fight the transfused blood. The result is an extremely fast destruction of red blood cells. This is why healthcare providers need to carefully check blood types before giving blood.
Some causes of hemolytic anemia are temporary. Hemolytic anemia is curable if a doctor can identify the underlying cause and treats 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 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 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
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. With blood types, a person can be either an Rh negative or an Rh positive. Some examples include A positive, A negative, AB negative, O positive, and other variations on these blood types.
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 medications 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.
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, and 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 severity of the condition, your age, your health, and your tolerance to certain medications.
Treatment options for hemolytic anemia include:
- blood transfusion
- intravenous immunoglobulin
- 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 Immunoglobulin (IVIG)
A low blood cell count can negatively affect the way your immune system fights infection. You may be given immunoglobulin intravenously 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. The spleen is where red blood cells are destroyed. Removing the spleen can reduce how fast red blood cells are destroyed. However, this is usually used as an option only after all other treatments have been used.
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.
Written by: April Kahn and Rachel Nall
Published on Oct 23, 2015
Medically reviewed on Oct 23, 2015 by Mark R Laflamme MD