What Is Hemolytic Anemia?
Hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) is a
rare form of
anemia
in which red blood cells are destroyed and removed from the bloodstream before
their usual lifespan is up. Healthy red blood cells usually live about 120 days
(4 months) in the bloodstream before the body removes them. In hemolytic
anemia, the body breaks down and removes red blood cells faster than it can
replace them. The breakdown of red blood cells is called hemolysis
(he-MOL-i-sis).
Anemia
The term “anemia” means that the number of
red blood cells in a person’s blood is less than normal or the red blood
cells don’t contain enough hemoglobin (HEE-moh-glow-bin). Hemoglobin is an
iron-rich protein in red blood cells that gives blood its red color. Anemia is
also known as having a “low blood count.”
The most common symptom of anemia is fatigue
(tiredness). Fatigue develops because the tissues of the body don’t
receive enough oxygen. The hemoglobin in red blood cells picks up oxygen in the
lungs and circulates it to the tissues of the body. If there aren’t enough
red blood cells, or not enough hemoglobin in the red blood cells, the blood
can’t carry enough oxygen to the rest of the body.
Red blood cells also are called RBCs or erythrocytes
(eh-RITH-roh-sites). Normal red blood cells are all about the same size and
look like tiny doughnuts without holes in the center. Normal red blood cells
have an average lifespan of 120 days, after which they die and are removed from
the bloodstream. The iron in the hemoglobin is recycled to make new red blood
cells. The marrow inside the large bones of the body continually produces new
red blood cells to replace the ones that have died.
The blood also contains two other types of cells:
white blood cells and platelets. White blood cells help fight infection.
Platelets help blood to clot. In some kinds of anemia, there are low amounts of
all three types of blood cells.
There are three main causes of anemia: blood loss,
lower than normal levels of red blood cell production, or higher than normal
rates of red blood cell destruction. More than one of these factors can combine
to cause anemia.
Hemolytic Anemia
Hemolytic anemia is due to increased hemolysis
(destruction) of red blood cells. The bone marrow increases production of red
blood cells to replace the hemolyzed blood cells, but it can’t produce
them fast enough to meet the body’s needs.
In some types of hemolytic anemia, the body makes
abnormal red blood cells that break down and hemolyze on their own. In other
types of hemolytic anemia, the body’s immune system, infections, certain
drugs, or other agents attack normal red blood cells, causing them to hemolyze.
The hemolysis can occur in the bloodstream or in an organ called the
spleen.
The two main types of hemolytic anemia are inherited
and acquired. In inherited hemolytic anemia, the condition is passed from
parent to child. In acquired hemolytic anemia, the person develops the
condition from some other cause. Hemolytic anemia can begin rapidly or come on
gradually and can range from mild to severe.
Outlook
Hemolytic anemia can often be successfully treated
or controlled. The course of hemolytic anemia depends on the cause and the
severity of the anemia. Mild hemolytic anemia may need no treatment at all.
Severe hemolytic anemia can be life threatening if it’s not treated.
If you have an inherited form of hemolytic anemia,
it’s a lifelong condition that requires ongoing treatment. If your anemia
is caused by an infection or use of a particular medicine, the anemia may go
away when the infection is treated or when the medicine is stopped.
Types of Hemolytic Anemia
There are many types of hemolytic anemia. Some types
are inherited, which means a person is born with them. Other types are
acquired, which means they develop in response to some other disease or
factor.
Inherited Types of Hemolytic Anemia
In the inherited hemolytic anemias, one or more of
the genes that control the production of red blood cells are defective, causing
the bone marrow to make abnormal cells. The red blood cell abnormality can
involve the cell membrane (the outer covering of the cell), the chemistry
inside the cell, or the production of abnormal types or amounts of hemoglobin.
The abnormal cells may be fragile and break down (hemolyze) on their own while
circulating in the bloodstream. Also, the body’s immune system may
recognize that the red blood cells are abnormal, and an organ called the spleen
may remove the cells from the bloodstream.
Sickle Cell Anemia
In
sickle
cell anemia, the body makes an abnormal type of hemoglobin. This hemoglobin
causes the red blood cells to take on an abnormal shape. Instead of their
normal shape (a doughnut without a hole) the red blood cells can turn into a
sickle (crescent) shape. Sickle cells die and are removed from the bloodstream
prematurely. In the United States, sickle cell anemia occurs most often in
African Americans. There also are other types of abnormal hemoglobin that can
cause hemolysis.
Thalassemia
The
thalassemias
are a group of anemias in which the body doesn’t make enough of certain
types of hemoglobin. This leads to abnormal red blood cells that die and are
removed from the body prematurely. Thalassemia is most common among people of
Mediterranean, African, or Southeast Asian descent.
Hereditary Spherocytosis
In hereditary spherocytosis (SFER-o-si-to-sis), an
abnormality of the surface membrane of red blood cells causes them to take on a
spherical (ball) shape. The abnormally shaped blood cells have a short
lifespan. Hereditary spherocytosis is the most common cause of hemolytic anemia
among people whose ancestors come from Northern Europe.
Hereditary Elliptocytosis (Ovalocytosis)
Hereditary elliptocytosis (e-LIP-to-si-TO-sis) is
another condition involving the cell membrane. It’s also known as
hereditary ovalocytosis. In this condition, the red blood cells are elliptic
(oval) in shape and not as flexible as normal red blood cells. These abnormal
red blood cells also have a short lifespan.
Glucose-6-Phosphate Dehydrogenase Deficiency
In glucose-6-phosphate dehydrogenase deficiency
(G6PD deficiency), the red blood cells are missing an important enzyme called
G6PD. G6PD is part of the normal chemistry inside red blood cells. In G6PD
deficiency, if red blood cells come into contact with certain substances in the
bloodstream, the missing enzyme causes the cells to rupture and die
prematurely. The hemolysis can be triggered by the person taking sulfa or
antimalaria medicines, eating fava beans, or having an infection. G6PD
deficiency mostly affects males of African or Mediterranean descent. It affects
about 1 in 10 African American males.
Pyruvate Kinase Deficiency
Pyruvate kinase also is an enzyme-deficiency
hemolytic anemia in which the missing enzyme is called pyruvate kinase. Not
having enough of this enzyme causes red blood cells to break down easily. This
disorder is more common among the Amish than other groups.
Acquired Types of Hemolytic Anemia
In acquired types of hemolytic anemia, the red blood
cells may be normal, but some other disease or factor causes the body to
destroy the red blood cells and remove them from the bloodstream. The
destruction of the red blood cells can occur in the bloodstream or, more
commonly, in the spleen.
Immune Hemolytic Anemia
In immune hemolytic anemia, the body’s immune
system destroys the body’s red blood cells. There are three main types of
immune hemolytic anemia: autoimmune, alloimmune, and drug-induced.
Autoimmune hemolytic anemia. In
autoimmune hemolytic anemia (AIHA), a person’s immune system mistakenly
produces antibodies directed against the person’s own red blood cells.
One-half of all cases of hemolytic anemia are AIHA. The cause of AIHA is
unknown. It may come on very quickly and become serious. It’s most common
in people over age 40.
Having certain diseases or infections can make a
person more likely to develop AIHA. These include chronic lymphocytic leukemia,
non-Hodgkin’s lymphoma, and other blood cancers; Epstein-Barr virus (which
causes infectious mononucleosis); cytomegalovirus (a virus that infects cells);
mycoplasma pneumonia (a lung infection); hepatitis; and human immunodeficiency
virus (HIV).
In some types of AIHA, the antibodies produced by
the body are called warm antibodies. This means they are active (that is, they
destroy red blood cells) at warm temperatures, such as body temperature. In
other types of AIHA, the body produces “cold-reactive antibodies,”
which means they become active when exposed to colder temperatures.
Cold-reactive antibodies can become active when the body (typically the hands
or feet) is exposed to temperatures of less than 32 to 50 degrees Fahrenheit (0
to 10 degrees Celsius). Warm antibody AIHA is more common than cold-reactive
antibody AIHA.
Alloimmune hemolytic anemia. In
alloimmune hemolytic anemia, antibodies are produced against the red blood
cells a person receives in a blood transfusion. If the blood type used for the
tranfusion is different than the recipient’s blood type, the
recipient’s immune system can develop antibodies that attack and destroy
the transfused blood cells.
Alloimmune antibodies also can develop as a result
of the mixing of blood between a pregnant woman and her baby at delivery. If
the mother’s blood type is Rh-negative and the baby’s is Rh-positive,
the mother can produce antibodies against the baby’s blood type. If a
mother develops anti-Rh antibodies as a result of one pregnancy, they can cross
the placenta during the next pregnancy and harm the fetus. To prevent this, a
medicine called RhoGam can be given at the time of delivery to block the
mother’s body from developing antibodies against the baby’s blood
type.
Drug-induced hemolytic anemia.
Certain drugs can cause a reaction that develops into hemolytic anemia. These
drugs include high doses of penicillin and related drugs, acetaminophen,
quinine and other drugs to treat malaria, anti-inflammatory drugs, and
levodopa.
Mechanical Hemolytic Anemias
Physical damage to red blood cell membranes can
result from microangiopathic (MI-kro-an-jee-o-PA-thik) changes in small blood
vessels. An artificial heart valve or other device used in blood vessels also
can damage red blood cell membranes. Damage can occur with a heart-lung bypass
machine during open-heart surgery. Damage also can occur with preeclampsia or
eclampsia (elevated blood pressure and protein in the urine after the 20th week
of pregnancy). Blood cell damage may occur in the limbs while participating in
marathons or other strenuous activities.
Paroxysmal Nocturnal Hemoglobinuria
Paroxysmal (par-ok-SIZ-mal) nocturnal hemoglobinuria
(PNH) is an acquired genetic disorder in which the red blood cells are abnormal
due to a lack of certain proteins. The body destroys these cells more rapidly
than normal. The destruction may occur continuously at a low level and flare up
at times (paroxysmal). People with PNH are at increased risk for blood clots in
the veins and low levels of white blood cells and platelets.
Other Causes of Damage to Red Blood Cells
Infections and other agents can invade and damage
red blood cells. Malaria and “blackwater fever,” tick-borne diseases,
snake venom, and toxic chemicals can attack and destroy red blood cells,
causing hemolytic anemia.
Other Names for Hemolytic Anemia
- Alloimmune hemolytic anemia
- Autoimmune hemolytic anemia
- Drug-induced hemolytic anemia
- Hemoglobin anemia, caused by glucose-6-phosphate
dehydrogenase deficiency
- Hemolytic anemia, caused by chemicals and
toxins
- Hereditary elliptocytosis
- Hereditary ovalocytosis
- Hereditary spherocytosis
- Idiopathic autoimmune hemolytic anemia
- Immune hemolytic anemia
- Microangiopathic hemolytic anemia
- Paroxysmal nocturnal hemoglobinuria
- Pyruvate kinase deficiency
- Sickle
cell anemia
- Thalassemia
What Causes Hemolytic Anemia?
There are many different types of hemolytic anemia.
The immediate cause of hemolytic anemia is the early destruction (hemolysis) of
red blood cells. The factors that cause early hemolysis can be inherited or
acquired. Sometimes, the cause of early hemolysis is not known.
Causes of Inherited Hemolytic Anemia
In inherited hemolytic anemias, there is a problem
with the genes that control the production of red blood cells. People with an
inherited hemolytic anemia received a defective red blood cell gene from one
(or both) of their parents. Different types of defective genes account for the
different types of inherited hemolytic anemias. In each of the types of
inherited hemolytic anemia, the body produces abnormal red blood cells. The red
blood cell abnormality can involve the cell membrane (the outer covering of the
cell), the chemistry inside the cell, or the production of abnormal
hemoglobin.
Causes of Acquired Hemolytic Anemia
In acquired types of hemolytic anemia, the body
produces normal red blood cells, but some disease or other factor destroys the
cells prematurely. The destruction of red blood cells can be caused by an
immune disorder, infection, reaction to a medicine, or reaction to a
transfusion. The early destruction of cells usually occurs in the spleen or the
bloodstream. The spleen is an organ in the upper left part of the abdomen that
helps remove abnormal blood cells from the bloodstream.
Who Is At Risk for Hemolytic Anemia?
Hemolytic anemia can affect people of all ages and
both genders. Most types of hemolytic anemia are equally common in men and
women and can develop at any age. Autoimmune hemolytic anemia is slightly more
likely in women over age 40. Glucose-6-phosphate dehydrogenase deficiency (G6PD
deficiency) is more common among males. People of all races can develop
hemolytic anemia. Some types of hemolytic anemia are more likely to occur in
certain populations than others.
In the United States,
sickle
cell anemia, one of the most common forms of hemolytic anemia, occurs
primarily among African Americans. G6PD deficiency affects males of African or
Mediterranean descent. About 1 in 10 African American men have G6PD deficiency.
What Are the Signs and Symptoms of Hemolytic
Anemia?
Signs and symptoms of hemolytic anemia depend on the
type of anemia and its severity. People with mild hemolytic anemia often have
no symptoms. However, if the anemia is severe, the symptoms increase and become
more serious. Many of the signs and symptoms of hemolytic anemia apply to all
anemias.
Signs and Symptoms of Anemia
The most common symptom of all types of anemia,
including hemolytic anemia, is fatigue (tiredness). Fatigue is caused by having
too few red blood cells to carry oxygen to the body. This lack of oxygen in the
body can cause you to feel weak or dizzy, have a headache, feel short of
breath, or even pass out when changing position (for example, standing up).
Since the heart must work harder to circulate the
reduced amount of oxygen in the blood, signs and symptoms of anemia may also
include a fast or irregular heartbeat or a
heart
murmur.
People with anemia may have pale skin, tongue, gums,
and nail beds due to the low levels of hemoglobin.
Signs and Symptoms of Hemolytic Anemia
The signs and symptoms associated with hemolytic
anemia include:
- Jaundice. This is a yellowish discoloration of
the skin and eyes. When red blood cells die, they release their hemoglobin into
the bloodstream. The hemoglobin is broken down by the body into a compound
called bilirubin, which gives the skin and eyes the yellowish color seen in
jaundice. It also causes the urine to be dark yellow or brown.
- Pain in the upper abdomen due to gallstones or an
enlarged liver. If you have high levels of bilirubin and cholesterol (from the
breakdown of red blood cells), they can form into stones in the gallbladder,
which can become painful.
- Leg ulcers and pain. In people with
sickle
cell anemia, the abnormal cells can clog small blood vessels, blocking
blood flow. This can cause leg sores and pain in different parts of the
body.
- A severe reaction to blood transfusion. Signs and
symptoms of a transfusion reaction include fever, chills, low blood pressure,
and
shock (a life-threatening condition that occurs when the body
isn’t getting enough blood flow).
How Is Hemolytic Anemia Diagnosed?
Hemolytic anemia is diagnosed using a combination of
medical and family history, physical exam, and diagnostic tests.
Specialists Involved
Primary care doctors, such as a family doctor or
pediatrician, may be involved in diagnosing and treating hemolytic anemia.
Other kinds of doctors involved include:
- A hematologist (blood disease specialist)
- A cardiologist (heart specialist)
Doctors and clinics that specialize in treating
inherited blood disorders, such as
sickle
cell anemia and
thalassemia,
may be involved. If you have an inherited form of hemolytic anemia, you may
want to consult a genetics counselor.
Medical and Family History
To determine the cause and severity of hemolytic
anemia, your doctor may ask detailed questions about your symptoms, personal
medical history, and your family medical history. You may be asked whether you
or anyone in your family has had problems with
anemia
in the past. Your doctor will want to know what illnesses or conditions you
have had recently and what medicines you take.
You also may be asked whether you have been exposed
to any drugs or chemicals or have an artificial heart valve or device that
could damage red blood cells.
Physical Exam
Your doctor will perform a physical exam to
determine how severe the anemia is and to check for possible causes. This exam
may include:
- Checking for jaundice (yellowish skin and
eyes)
- Listening to your heart for a rapid or abnormal
heartbeat
- Listening for rapid or uneven breathing
- Feeling your abdomen to check the size of your
liver and spleen
- Performing a pelvic and rectal exam to check for
internal bleeding
Diagnostic Tests and Procedures
Your doctor may perform a number of tests, including
the following:
Blood Tests
Complete blood count. Usually, the
first test used to diagnose anemia is a complete blood count (CBC). The CBC
tells a number of things about a person’s blood, including:
- The hemoglobin level. Hemoglobin is the iron-rich
protein in red blood cells that carries oxygen through the body. The normal
range of hemoglobin levels for the general population is 11–15 g/dL. A low
hemoglobin level means a person has anemia.
- The hematocrit (hee-MAT-oh-crit) level. The
hematocrit level measures how much of the blood is made up of red blood cells.
The normal range for hematocrit levels for the general population is 32–43
percent. A low hematocrit level is another sign of anemia.
The normal range of these levels may be different in
certain racial and ethnic populations. Your doctor can explain your individual
test results.
The CBC also checks:
- The number of red blood cells. Too few red blood
cells means a person has anemia. A low number of red blood cells is usually
seen with either a low hemoglobin or a low hematocrit level, or both.
- Red blood cell size. The mean cell volume
measures the average size (volume) of red blood cells. Red blood cells can be
normal sized, smaller, or larger, depending on the type of anemia.
- The number of white blood cells. White blood
cells are involved in fighting infection.
- The number of platelets. Platelets are small
cells that are involved in blood clotting.
Additional blood tests. If the CBC
results confirm you have anemia, your doctor may order additional blood tests
to determine the type and cause of the anemia. Some of the tests that can be
used in the diagnosis of hemolytic anemia include:
- Reticulocyte (re-TIK-u-lo-site) count.
Reticulocytes are young red blood cells. The reticulocyte count measures the
rate at which the bone marrow is producing new red blood cells. Typically in
hemolytic anemia, the reticulocyte count is higher than normal because the bone
marrow is working overtime to replace the destroyed red blood cells.
- Peripheral smear. This test involves looking at
the blood cells through a microscope. Some types of hemolytic anemia involve
abnormally shaped red blood cells, which can be seen through a microscope.
- Coombs’ test. The Coombs’ test measures
the presence of antibodies directed against red blood cells.
- Haptoglobin, bilirubin, and liver function tests.
When red blood cells break down, they release their hemoglobin into the
bloodstream. The hemoglobin combines with a chemical called haptoglobin. A low
level of haptoglobin in the bloodstream is an indication of hemolytic anemia.
Bilirubin comes from the breakdown of hemoglobin. High levels of bilirubin
cause jaundice, a yellowish discoloration to the skin and eyes. High levels of
bilirubin in the blood occur with the hemolysis of red blood cells, and also
with some liver and gallbladder diseases. Liver function tests help to
determine whether high bilirubin levels are from hemolytic anemia or
liver/gallbladder disease.
- Hemoglobin electrophoresis. This test detects
abnormal hemoglobin, which is the cause of some types of hemolytic anemia.
- Testing for paroxysmal nocturnal hemoglobinuria
(PNH). In PNH, the red blood cells are missing certain proteins. The test for
PNH looks for red blood cells that are missing these proteins.
- Osmotic fragility test. This test looks for
abnormally fragile red blood cells, which are seen in hereditary
spherocytosis.
- Testing for glucose-6-phosphate dehydrogenase
deficiency (G6PD) deficiency. This test, called a rapid fluorescent spot test,
detects evidence of G6PD enzyme activity in a sample of blood.
Bone Marrow Tests
In some cases, the doctor may want to examine the
cells of the bone marrow under a microscope. A sample of bone marrow can be
obtained with either a bone marrow biopsy or aspiration. A bone marrow biopsy
is a minor surgical procedure to remove a small amount of bone marrow tissue.
For a bone marrow aspiration, your doctor removes a small amount of bone marrow
fluid through a needle.
Tests for Other Causes of Anemia
Because anemia has many causes, the doctor may order
tests for conditions such as:
- Kidney failure
- Lead poisoning
- Low levels of vitamins, including vitamin B12,
vitamin C, and folate
- Iron deficiency
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.
How Can Hemolytic Anemia Be Prevented?
Hemolytic anemia can’t be prevented in people
who are born with the genes for inherited types of hemolytic anemia. One
exception is glucose-6-phosphate dehydrogenase (G6PD) deficiency. A person born
with G6PD deficiency can prevent the development of anemia by avoiding
substances, such as fava beans and certain medicines, which can trigger
hemolysis.
Transfusion reactions, which can cause hemolytic
anemia, can be prevented by ensuring a match of the blood types between the
donor and recipient. When a pregnant woman has Rh-negative type blood and her
fetus has Rh-positive type blood, a medicine called RhoGam given at the time of
delivery can block the mother’s body from developing antibodies against
the baby’s blood type.
Living With Hemolytic Anemia
The course of hemolytic anemia depends on the cause
and the severity of the anemia. Mild hemolytic anemia may need no treatment at
all. If you have an inherited form of hemolytic anemia, it is a lifelong
condition that may require ongoing treatment. If the anemia is caused by a
medicine or infection, the anemia may go away when the medicine is stopped or
the infection is cured.
Ongoing Health Care Needs
If you have hemolytic anemia, taking care of your
overall health is important. See your doctor regularly for checkups and follow
your treatment plan. Get a flu shot every year, and ask your doctor about the
vaccine to prevent pneumoccal pneumonia.
Be sure to get plenty of rest. Stay away from cold
temperatures if you have cold-reactive antibody autoimmune hemolytic anemia.
During cold weather, wear a hat, scarf, and a warm coat. When taking cold food
out of the refrigerator or freezer, wear gloves. Turn down air conditioning or
dress warmly while in an air conditioned space, and warm up the car before
driving in cold weather.
If you have glucose-6-phosphate dehydrogenase
deficiency, avoid taking sulfa or antimalaria medicines and eating fava beans.
You should also take precautions to avoid infections.
Recommended Physical Activity
Discuss with your doctor the safest types and
amounts of physical activity for you. You may need to avoid certain sports or
activities that could worsen your condition or lead to complications.
Protection From Infection
Your doctor also may discuss ways to reduce your
chance of getting an infection. These include staying away from people who are
ill and avoiding crowds. Washing your hands thoroughly several times a day and
caring for your teeth and gums can reduce the risk of infection.
For Parents of Children With Hemolytic Anemia
Parents of children with hemolytic anemia usually
want to learn as much as possible about the illness from the team treating
their child. You can be an active partner in caring for your child by speaking
with the health care provider team about treatment, diet, and level of physical
activity. Learn to watch for signs of worsening anemia or possible
complications so you can contact your child’s doctor.
It’s a good idea for parents to educate their
family members, friends, and child’s classmates about the illness. You
also can inform your child’s teachers or other caregivers so they know
about any necessary limitations or restrictions. Family members, friends,
teachers, and caregivers can provide a network of support to help your child
cope with his or her anemia.
Allow teenagers to have input in decisions about
their care. This encourages them to take an active role in their health care.
Help them understand about lifestyle restrictions and their medical needs so
they can better cope with having anemia.
Support Groups
The
American Sickle Cell Anemia Association provides research,
education, and social services. The
Cooley’s Anemia Foundation provides information about
thalassemia.
Key Points
- Hemolytic anemia is a rare form of
anemia
in which red blood cells are destroyed (hemolyzed) and removed from the
bloodstream before their usual lifespan is up.
- The two main types of hemolytic anemia are
inherited and acquired. In inherited hemolytic anemia, the condition is passed
from parent to child. In acquired hemolytic anemia, the person develops the
condition from some other cause.
- In inherited hemolytic anemias, the body produces
abnormal red blood cells that die or are destroyed by the body prematurely. The
red blood cell abnormality can involve the cell membrane (the outer covering of
the cell), the chemistry inside the cell, or the production of abnormal
hemoglobin.
- Acquired hemolytic anemias are caused by immune
system disorders, medicine reactions, infections, and reactions to transfusion
of incompatible blood types.
- In some cases of hemolytic anemia, the exact
cause cannot be found.
- Hemolytic anemia can affect people of all ages
and both genders. Some types of hemolytic anemia are more likely to occur in
certain populations than others.
- Common signs and symptoms of hemolytic anemia are
feeling weak and fatigued (very tired) and having shortness of breath. People
with hemolytic anemia may be jaundiced (have a yellow discoloration of the skin
or eyes), have dark urine, or have an enlarged spleen.
- Hemolytic anemia is diagnosed based on a
combination of medical and family history, physical exam, and diagnostic test
results. A complete blood count is often the first test used to diagnose
anemia. Additional tests may be needed to determine the specific type of
hemolytic anemia so that effective treatment can be prescribed.
- The course of hemolytic anemia depends on the
cause and the severity of the anemia. Mild hemolytic anemia may need no
treatment. If you have an inherited form of hemolytic anemia, it’s a
lifelong condition that may require ongoing treatment. If a medicine or
infection causes the anemia, it may go away when the medicine is stopped or the
infection is cured. Severe hemolytic anemia can be life threatening if
it’s not treated.
- Treatments for hemolytic anemia include blood
transfusion, medicines, plasmapheresis (treatment to remove antibodies from red
blood cells), surgery, bone marrow or stem cell transplant, and lifestyle
changes.
- People with hemolytic anemia may need to avoid
certain sports or activities that could worsen their condition or lead to
complications. A doctor can recommend safe types and amounts of physical
activity.
Links to Other Information About Hemolytic
Anemia
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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DCI Home:
Blood Diseases: Hemolytic Anemia: Printer Friendly Summary Page 
