Diagnosing & Treating Hemolytic Anemia

Red blood cells transport oxygen throughout the body. When you have anemia, you don't have a sufficient number of healthy red blood cells. When you have hemolytic anemia, red blood cells are destroyed faster than usual. Some cases of hemolytic anemia are chronic and slow, while others can be life-threatening.

This article will cover the causes of hemolytic anemia in children and adults, symptoms, the three different types, and the most common treatment methods used.

What Causes Hemolytic Anemia?

Your body makes new red blood cells in the bone marrow, the soft tissue in bones where all blood cells are formed. When you have hemolytic anemia, red blood cells are destroyed through a process called hemolysis.

There are several potential causes for hemolytic anemia, including:

• Autoimmune diseases, in which your immune system perceives red blood cells as foreign invaders and then destroys them, such as lupus and vasculitis
• A blood clot
• Genetic disorders that affect red blood cells, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency, sickle cell disease, and thalassemia
• Being exposed to some types of chemicals and toxins
• Having a blood transfusion from a donor who doesn't have the same blood type as you
• Infections such as hepatitis, cytomegalovirus (CMV), Epstein–Barr virus (EBV), and others

Symptoms

Not everyone with hemolytic anemia will have symptoms, especially if their case is mild. Common symptoms of hemolytic anemia include:

• Breathing problems with physical activity
• Fatigue
• Feeling dizzy or light-headed
• An irregular heartbeat
• Yellowing of the eyes and skin (this is called jaundice)
• Dark-colored urine

Other symptoms that may occur include:

• Fever
• A heart murmur
• Kidney failure
• Pale skin
  

Types of Hemolytic Anemia

There are three types of hemolytic anemia: extrinsic, intrinsic, and erythroblastosis fetalis.

Extrinsic

The term "extrinsic" is used to describe hemolytic anemia caused by something other than the red blood cells themselves. Causes of extrinsic hemolytic anemia include:

• Autoimmune diseases such as lupus or rheumatoid arthritis
• Certain types of cancer like leukemia or lymphoma
• Infections such as Epstein-Barr virus or hepatitis
• The use of certain medications, such as penicillin, antimalaria medications, or Tylenol (acetaminophen), although not everyone using these medications will get hemolytic anemia

Intrinsic

When red blood cells get destroyed more rapidly because of a defect in the cells, this is called intrinsic hemolytic anemia.

Disorders that can lead to intrinsic hemolytic anemia include:

• G6PD deficiency
• Red cell membrane disorders
• Sickle cell disease
• Thalassemia

Erythroblastosis Fetalis

This is the name for hemolytic anemia in a newborn or fetus. It is caused by the destruction of red blood cells by maternal immunoglobulin G (IgG) antibodies.

In some people, hemolytic anemia is temporary. For others, it will occur and then recur chronically.

Diagnosis

A healthcare provider who suspects hemolytic anemia will ask you about your symptoms and perform a physical exam. Other tests you may need include:

• A complete blood count (CBC): This is a type of lab test that measures your overall health through your blood. You may also have other blood tests, particularly if the complete blood count indicates that you have anemia.
• Bone marrow aspiration (or bone marrow biopsy): This test will examine the number and size of your blood cells. It is done by removing a small sample of bone marrow fluid or solid bone marrow tissue.
• Urine test: A urine test can be analyzed for hemoglobin and iron. Hemoglobin is a type of protein found in red blood cells.

Treating Hemolytic Anemia

Your healthcare provider will decide on the best treatment for your hemolytic anemia based on your age, medical history, and the severity of your anemia. Here is more information on some of the most common treatments used:

• Red blood cell transfusion: This type of treatment will raise the number of red blood cells in your body, helping to offset the insufficiency caused by anemia.
• Corticosteroids: This medication can help control an overactive immune system. Using corticosteroids for hemolytic anemia can potentially slow down red blood cell destruction.
  
• Immune globulin (IVIG): This is an infusion containing antibodies that will slow down the destruction of red blood cells that is caused by hemolytic anemia.
• Immunosuppressants: When your own immune system is destroying red blood cells, immunosuppressants can be an option. This may include medicines like Azasan (azathioprine) or Cytoxan (cyclophosphamide). It is used more frequently when other treatments do not work.
• Surgery: A surgery called a splenectomy removes the spleen. A splenectomy may be used if red blood cell destruction is taking place in the spleen and if you are not responding to other treatments.

Summary

Hemolytic anemia is the name for a condition in which your body destroys red blood cells too quickly. It has several potential causes, including certain genetic disorders and autoimmune diseases. Symptoms may include fatigue and breathing problems.

A complete blood count and other diagnostic tests can help a healthcare provider determine if you have hemolytic anemia. Treatments include a red blood cell transfusion, IVIG, and immunosuppressants.

A Word From Verywell

It can be discouraging to experience symptoms of hemolytic anemia, especially since symptoms can indicate so many other health conditions. Keep in mind that although hemolytic anemia can be serious, it also is treatable. If you have hemolytic anemia, work with your healthcare provider to find the best treatment for you.