Hemolytic anemia
Hemolytic anemia is a condition characterized by the premature destruction of red blood cells, leading to a deficit that the bone marrow cannot compensate for. This anemia can be categorized into two main types: intrinsic, resulting from defects within the red blood cells themselves due to inherited conditions, and extrinsic, where healthy red blood cells are destroyed by external factors like infections or medications. Patients undergoing chemotherapy or radiation, as well as those with certain autoimmune disorders, are at heightened risk. Symptoms often include pale skin, jaundice, dark urine, fever, and fatigue, which can significantly impact daily life. Diagnosis typically involves laboratory tests to assess red blood cell counts and function. Treatment options vary based on severity and may include blood transfusions, medications, or in some cases, surgery to remove the spleen. While intrinsic hemolytic anemia cannot be prevented, avoiding certain medications can help in preventing extrinsic forms. The prognosis for individuals can differ widely, with some cases requiring lifelong management, especially for inherited types.
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Hemolytic anemia
ALSO KNOWN AS: Autoimmune hemolytic anemia, cancer-related microangiopathic hemolytic anemia (CR-MAHA), hemolytic anemia of malignancy
RELATED CONDITIONS: Lymphoproliferative disorders including chronic lymphocytic leukemia, lymphoma, multiple myeloma, and thymoma. It is sometimes seen in patients with breast, stomach, colon, prostate, lung, cervix, and pancreas cancers and patients with hepatitis, cytomegalovirus, or streptococcus.
DEFINITION: Hemolytic anemia occurs when there are too few red blood cells in the body due to premature destruction of red blood cells. Destruction occurs more quickly than the bone marrow can produce new cells.
Risk factors: Patients receiving chemotherapy or radiation to treat lymphoproliferative disease or solid tumors of the breast, stomach, colon, prostate, lung, cervix, or pancreas are at risk for developing hemolytic anemia. Also at risk are people with infections like hepatitis, cytomegalovirus, or streptococcus, or those taking penicillin, sulfa drugs, or large quantities of acetaminophen. People diagnosed with autoimmune disorders, lupus, rheumatoid arthritis, or ulcerative colitis can also be at risk.
Etiology and the disease process: This destruction of red blood cells, or hemolysis, falls into intrinsic and extrinsic groups. Intrinsic refers to the destruction of the red blood cells due to a defect within the cells themselves. Intrinsic hemolysis is caused by an inherited condition such as sickle cell anemia or thalassemia, which causes red blood cells to have a shorter life span than usual. Extrinsic refers to red blood cells that develop healthily but are destroyed by infection or drugs. Extrinsic hemolysis can be temporary and resolve over several months.
Incidence: Of all overt hemolytic anemia cases, around 15 percent are associated with cancer. Some 20 percent of hemolytic anemias are caused by lymphocytic leukemia, 10 percent are the result of an autoimmune disease, and all others are related to medications. Women are twice as likely to contract hemolytic anemia as men. One in 80,000 cases of anemia is hemolytic anemia.
Symptoms: Symptoms of hemolytic anemia include pale skin, a yellowing of the skin or eyes, dark urine, fever, weakness, dizziness, confusion, inability to tolerate physical activity, an enlarged spleen and liver, rapid heart rate, or heart murmur.
Screening and diagnosis: A patient who visits their physician complaining of tiredness, dizziness, or pale skin may be diagnosed with hemolytic anemia. The physician will order laboratory tests to monitor the patient’s red blood cell count. Laboratory tests include hemoglobin levels, reticulocyte counts, liver function tests, and, in more serious conditions, a bone marrow aspiration and biopsy. A urine sample can evaluate increased proteins or hemoglobin.
Treatment and therapy: Treatment is based on the patient’s overall condition and type of anemia. The patient’s age, medical history, cause of disease, and ability to tolerate treatment are considered. Treatment includes blood transfusions, steroid medications, and infusions of immune globulins to strengthen the immune system. More severe cases are treated with surgical removal of the spleen or immunosuppressive therapy.
Prognosis, prevention, and outcomes: There is no known prevention for intrinsic hemolytic anemia. Extrinsic hemolytic anemia can be prevented by avoiding medications that may cause anemia. Mild cases may not need treatment, but severe cases are often life-threatening. An inherited form of anemia will require lifelong treatment.
Bibliography
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