Hemolytic Anemia

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Hemolytic Anemia
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Overview

Overview

Hemolytic anemia is a type of anemia that is as a result of destruction, or hemolysis, of the red blood cells in the blood stream. There are numerous conditions that can lead to haemolytic anemia, and these include those that occur in the blood vessels (intravascular) and elsewhere in the body (extravascular).

In general, though, the classification of haemolytic anemia can be divided into acquired or inherited causes. The management of haemolytic anemia will therefore depend on the cause of the red blood cell damage.

Etiology

Inherited causes of haemolytic anemia are related to the red blood cells themselves which causes them to become dysfunctional. They include the following conditions:

Acquired causes of haemolytic anemia are related to factors that physically affect the red blood cells causing them to become damaged. They include the following factors and conditions:

  • Immune mediated responses – the body’s immune system produces proteins that attack and damage the red blood cells. This occurs in autoimmune haemolytic anemia, which itself is caused by various conditions such as viral infections and other autoimmune conditions like lupus and rheumatoid arthritis.
  • Increased activity of the spleen (hypersplenism) – this in itself may be caused by portal hypertension.
  • Lead poisoning – exposure to this heavy metal results in damage to red blood cells.
  • Prosthetic valves – damage to the red blood cells is caused by physical trauma by these valves as they pass through them.
  • Paroxysmal nocturnal hemoglobinuria – a rare cause of hemolysis that is characterized by abnormalities of the complement proteins in the blood.

Signs and symptoms

The clinical presentation of patients with haemolytic anemia is similar to anemia. The signs and symptoms will therefore include skin and mucus membrane paleness, fatigue, weakness and dizziness. In more severe cases, patients may present with shortness of breath, heart palpitations and loss of consciousness.

The added clinical features or haemolytic anemia is jaundice (yellow discoloration of the skin and/or eyes) and dark-colored urine as a result of bile being released when red blood cells rupture.

Complications may include heart failure, due to the decreased oxygen-carrying capacity of blood, and gallstones, due to the increased release of bile in the blood stream.

Diagnosis

Hemolytic anemia will be suspected on the medical history given by the patient and the clinical findings made on examination.

The cause of the hemolysis will be determined by performing various blood tests and investigations. These include a complete blood count and peripheral smear to determine the amount and morphology of the red blood cells, and biopsy and examination of the bone marrow to determine the cause of the problem.

Bilirubin and lactate dehydrogenase levels will also be tested for because they are both released from destroyed red blood cells. Autoimmune haemolytic anemia will be confirmed with a direct Coombs test which seeks out antibodies that are bound to the red cells.

Management

In severe anemia, blood transfusions are performed. The exception is in autoimmune haemolytic anemia which is managed by reducing the immune reaction, associated with the condition, with steroid therapy.

In cases where steroids are ineffective, patients are administered medications such as rituximab.

In severe cases of hemolysis, where the patient’s life is in danger, intravenous steroids and immunoglobulin are transfused.

In situations where these treatment options don’t work, or the cause of the hemolysis is due to increased activity of the spleen, the organ is surgically removed (splenectomy).