Hemolytic Anemia: What It Is, Types, Symptoms, and Causes

Hemolytic anemia is a condition in which red blood cells break down faster than the bone marrow can produce new ones. It sounds scary, but this group of diseases has many different causes and courses: from mild forms without symptoms to serious ones. Let's break down in plain terms what happens and which examinations help figure it out.

What is hemolytic anemia

Red blood cells normally live up to 120 days, then naturally break down — most often in the spleen. This breakdown is called hemolysis. If destruction proceeds faster than the bone marrow can produce replacements, hemolytic anemia develops. It can be mild or serious, and may develop quickly or slowly. It is not a single diagnosis but a group of conditions with different mechanisms.

Why red blood cells break down: main causes

Causes are divided into hereditary and acquired. Hereditary causes include defects in the proteins of the red blood cell "framework," enzyme deficiencies, and hemoglobinopathies — sickle cell anemia and thalassemia. Acquired variants are associated with immune attack on one's own cells, infections, certain medications, chemicals and toxins, blood clots in small vessels, blood type mismatch during transfusion, damaged or artificial heart valves. Another cause is bone marrow failure, when there simply aren't enough new cells.

Autoimmune hemolytic anemia: what it is

Here the immune system mistakenly considers its own red blood cells foreign and destroys them. Antibodies can be "warm" — active at body temperature, and "cold" — working only in the cold. Symptoms resemble other anemias: weakness, rapid heartbeat, dizziness. Some cases remain without a clear external cause, while others are associated with other diseases, including lymphoma, where anemia sometimes becomes the first manifestation.

Microspherocytosis — a hereditary form

The microspherocytic form belongs to membranopathies (disorders of red blood cell structure) and is hereditary. The spleen filters the blood and removes old and altered cells.

Symptoms of hemolytic anemia

With mild anemia, there may be no complaints at all. If the problem progresses slowly, the first to appear are fatigue, weakness during usual activities, a feeling that the heart is pounding, headaches, and difficulty concentrating. Further — pallor, shortness of breath, dizziness upon standing, painful tongue, pain in the left upper abdomen due to an enlarged spleen.

• darkening of urine
• yellowish, "lemon" tint of skin and mucous membranes
• enlarged spleen or liver
• tendency to thrombosis in some forms
• fever, chills, back and abdominal pain during hemolytic crisis

The presence of a diagnosis alone is not a reason to call an ambulance. 103 or 112 — for a life-threatening condition, such as stroke or heart attack.

Which tests detect hemolysis and when to see a doctor

It starts with an examination and a complete blood count: the number of red blood cells, hemoglobin, and hematocrit are checked. Then the doctor may order reticulocytes, haptoglobin and lactate dehydrogenase, Coombs test (direct and indirect), cold agglutinins, free hemoglobin in serum or urine, Donath-Landsteiner test, pyruvate kinase activity. The list of possible examinations also includes urinalysis, bone marrow examination, and genetic tests. One goes to the doctor when symptoms of anemia appear: weakness, shortness of breath, jaundice, dark urine. Severe anemia without monitoring is dangerous — it worsens the course of heart and lung diseases, causes rhythm disturbances and heart failure.

This text is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer