How Is Hemolytic Anemia Treated?

Goals of Treatment

The goals of treating hemolytic anemia are to reduce or stop the hemolysis of red blood cells, to increase the red blood cell count to normal levels, and to treat the underlying cause.

The treatment you receive will depend on the type, cause, and severity of the hemolytic anemia you have. Your age, overall health, and medical history also will be considered. If you have an inherited form of hemolytic anemia, it's a lifelong condition that may require ongoing treatment. If you have an acquired hemolytic anemia, the anemia may go away if the underlying cause can be found and corrected.

Who Needs Treatment

Severe hemolytic anemia usually requires ongoing treatment and can be life threatening if left untreated. A person with mild hemolytic anemia may not need treatment as long as the condition doesn't get worse.

Types of Treatment

Treatments for hemolytic anemia include blood transfusion, medicines, lifestyle changes, plasmapheresis (treatment to remove antibodies from red blood cells), surgery, and bone marrow or stem cell transplant.

Blood Transfusions

Blood transfusions are used to treat severe or life-threatening anemia. Transfusions are given through a vein and require careful matching of donated blood with the recipient's blood. The transfused blood must be compatible with the recipient's blood type (for example, type A, Rh-negative). People who receive blood transfusions on a regular basis must be monitored and treated for a buildup of too much iron in the body.

Medicines

Some types of hemolytic anemia, particularly autoimmune hemolytic anemia (AIHA), can be improved with medicines. Corticosteroid medicines, such as prednisone, can be used to suppress the immune response against red blood cells. If there is no response to corticosteroids, other drugs that suppress the immune system, such as azathioprine, cyclophosphamide, or danazol, may be prescribed.

Intravenous (IV) gamma globulin may also be given to suppress antibody formation if the person does not respond to corticosteroids. Rituximab is being tried experimentally for AIHA. This drug reduces hemolysis by suppressing the immune system cells that produce the antibodies against red blood cells. An experimental medicine called eculizumab is being studied as a treatment for paroxysmal nocturnal hemoglobinuria (PNH). Eculizumab is an antibody directed against part of the immune system that is involved in PNH.

Plasmapheresis

Plasmapheresis removes antibodies from red blood cells. It may help if other treatments for immune hemolytic anemia don't work.

Surgery

In some cases of hemolytic anemia, it's necessary to surgically remove the spleen. The spleen is an organ in the upper left part of the abdomen that helps remove abnormal red blood cells from the bloodstream. The spleen also can contribute to some types of hemolytic anemia. An enlarged or diseased spleen removes more red blood cells than normal, causing anemia. Removal of the spleen may be necessary to stop or reduce high rates of red blood cell destruction.

Bone Marrow or Stem Cell Transplant

Hemolytic anemia that results from the failure of bone marrow to make normal red blood cells (such as in thalassemia) is sometimes treated with bone marrow or stem cell transplants. Donor marrow is usually taken from a large bone, such as the pelvis. Marrow is given by transfusion through a vein. Stem cells for a transplant can be from matched umbilical cord blood, from bone marrow donated by a family member, or from a matched but unrelated donor. Stem cells in bone marrow develop into mature blood cells.

Lifestyle Changes

For people with AIHA with cold-reactive antibodies, avoiding exposure to cold temperatures can help prevent hemolysis of their red blood cells. It's especially important to protect the fingers, toes, and ears from the cold. Typical ways to protect from cold include:

• Wear gloves or mittens when taking food out of the refrigerator or freezer.
• Wear a hat, scarf, and a coat with snug cuffs during cold weather.
• Turn down air conditioning or dress warmly while in an air conditioned space.
• Warm up the car before driving in cold weather.

People born with glucose-6-phosphate dehydrogenase deficiency can prevent the development of anemia by avoiding substances that can trigger hemolysis, such as fava beans and certain medicines.