Blood Disorders Anemia Causes and Treatment of Drug-Induced Hemolytic Anemia By Amber Yates, MD Amber Yates, MD LinkedIn Twitter Amber Yates, MD, is a board-certified pediatric hematologist and a practicing physician at Baylor College of Medicine. Learn about our editorial process Updated on July 07, 2021 Medically reviewed by Douglas A. Nelson, MD Medically reviewed by Douglas A. Nelson, MD LinkedIn Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Diagnosis Causes Treatment Options Hemolytic anemia describes a large group of conditions characterized by accelerated destruction of red blood cells. The average lifespan of a red blood cell is 120 days. At the end of 120 days, the red blood cell is broken down and the parts of it are recycled to make new ones. When your red blood cells are broken down faster than this, it is called hemolysis. Caiaimage / Martin Barraud / Creative RF / Getty Images Hemolysis can be caused by many different things. Some forms you inherit, like hereditary spherocytosis and pyruvate kinase deficiency. Others are caused by your immune system breaking down the red blood cells, like autoimmune hemolytic anemia or hemolytic disease of the newborn. In drug-induced hemolytic anemia, there are several different mechanisms that cause hemolysis when you are exposed to the medication or toxin. Signs and Symptoms Signs and symptoms of drug-induced hemolytic anemia are similar to other forms of hemolytic anemia. These symptoms vary slightly based on whether the red blood cell is broken down while in circulation (intravascular hemolysis) or outside the vascular system (predominantly liver and spleen). Symptoms may include: Jaundice, yellowing of the skinDark (tea or cola-colored) urinePallor, pale coloring of the skinFatigue, tirednessDizzinessElevated heart rateShortness of breathSplenomegaly (enlarged spleen) Diagnosis Diagnosis of drug-induced hemolytic anemia starts like most forms of anemia—by ordering a complete blood count (CBC). Anemia is indicated by low hemoglobin and/or hematocrit. In hemolytic anemia, red blood cell production is accelerated resulting in an increased number of reticulocytes (immature red blood cells). This count may be reported as a percentage or absolute reticulocyte count (ARC), or "retic." To diagnose hemolytic anemias, it is important for either your hematologist or a pathologist to look at your red blood cells under the microscope. This is called a peripheral blood smear. A red blood cell normally looks round, similar to a donut under the microscope. When a red blood cell is destroyed prematurely, it becomes fragmented or shaped like a sphere or globe. Some medications cause an immune hemolytic anemia similar to autoimmune hemolytic anemia. If you have this, a test called the direct antiglobulin test (DAT or Direct Coombs) will be positive, indicating that your immune system is attacking and destroying your red blood cells inappropriately. Because the red blood cell releases bilirubin, a pigment that causes jaundice, your levels of bilirubin might be elevated (as evidenced by a bilirubin test). Otherwise, there are no specific tests to determine if your medication is the cause of your hemolytic anemia. In general, the diagnosis is confirmed if your anemia improves after discontinuing the medication. Causes There are several medications associated with drug-induced hemolytic anemia. The most common culprits are: Cephalosporins, a common antibiotic, including ceftriaxonePenicillins, in particular, piperacillinDiclofenac, a non-steroidal anti-inflammatoryOxaliplatin, a chemotherapeutic medication A related condition is a glucose-6-phosphate dehydrogenase (G6PD) deficiency. In this type of anemia, you are missing a key enzyme (chemical) in the red blood cell. If you are exposed to certain medications like sulfa antibiotics, your red blood cells may hemolyze, causing anemia. If you have G6PD deficiency, it is important for you to know what medications/foods you should avoid. Treatment Options Treatment options are determined by how severe your anemia is. First, the medication/toxin that is causing hemolytic anemia should be stopped. Blood transfusions can be given if necessary. If hemolysis is severe, it may cause kidney injury. Fortunately, this is typically temporary and improves once the hemolysis resolves, though some may require dialysis for a period of time. A Word From Verywell It may seem strange to learn that a medication you were taking for another medical condition caused your anemia. Fortunately, removing the offending medication will keep the hemolysis from worsening. It is important to discuss with your physician what medication caused the anemia so that you can avoid using it in the future. 13 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Arias CF, Arias CF. How do red blood cells know when to die? R Soc Open Sci. 2017;4(4):160850. doi:10.1098/rsos.160850 National Center for Advancing Translational Sciences. Hereditary spherocytosis. National Center for Advancing Translational Sciences. Pyruvate kinase deficiency. National Center for Advancing Translational Sciences. Autoimmune hemolytic anemia. MedlinePlus. Hemolytic disease of the newborn. MedlinePlus. Drug-induced immune hemolytic anemia. Lab Tests Online. Anemia testing. Lab Tests Online. Reticulocytes. Ford J. Red blood cell morphology. Int J Lab Hematol. 2013 Jun;35(3):351-7. doi:10.1111/ijlh.12082 Zantek ND, Koepsell SA, Tharp DR Jr, Cohn CS. The direct antiglobulin test: A critical step in the evaluation of hemolysis. Am J Hematol. 2012 Jul;87(7):707-9. doi:10.1002/ajh.23218 Pierce A, Nester T. Pathology consultation on drug-induced hemolytic anemia. Am J Clin Pathol. 2011 Jul;136(1):7-12. doi:10.1309/AJCPBVLJZH6W6RQM Youngster I, Arcavi KA, Schechmaster R, et al. Medications and glucose-6-phosphate dehydrogenase deficiency: An evidence-based review. Drug Saf. 2010 Sep 1;33(9):713-26. doi:10.2165/11536520-000000000-00000 Brodsky R. Drug-induced hemolytic anemia. UpToDate. Additional Reading Schrier SL. Hemolytic anemia due to drugs and toxins. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA. Schrier SL and Brugnara C. Pathogenesis of autoimmune hemolytic anemia: Warm agglutinins and drugs. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA. By Amber Yates, MD Amber Yates, MD, is a board-certified pediatric hematologist and a practicing physician at Baylor College of Medicine. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit