Hemolytic Anemia

Overview

What is hemolytic anemia?

Hemolytic anemia is a blood disorder that makes your red blood cells break down or die faster than your body can replace them with new blood cells. People may develop hemolytic anemia due to genetic conditions that cause anemia. Sometimes, people have mild hemolytic anemia symptoms that go away after treatment. Many times, healthcare providers can cure hemolytic anemia after finding out what caused the condition. Left untreated, however, severe hemolytic anemia can cause serious heart trouble.

What type of anemia is hemolytic anemia?

There are many different types of anemia. Hemolytic anemia happens when your red blood cells break down or die faster than they usually do. Red blood cells normally live for about 120 days. When they break down or die sooner than that, your bone marrow doesn’t have time to produce enough new red blood cells, leaving you with a low red blood cell count. Other anemia types may occur when:

  • Injury or illness causes excessive bleeding that drains your red blood cell supply faster than your body can replace it.
  • Something affects red blood cell production so your body either produces fewer red blood cells or produces abnormal red blood cells.

Hemolytic anemia is less common than anemia caused by excessive bleeding or slow red blood cell production.

What happens if hemolytic anemia is not treated?

Severe hemolytic anemia can lead to serious heart conditions, including arrhythmia (abnormal heart rhythm), cardiomyopathy and heart failure.

Who is affected by hemolytic anemia?

There are several kinds of hemolytic anemia, and each of these may affect people of all age groups, races and genders.

What’s the difference between hemolytic anemia and autoimmune hemolytic anemia?

Autoimmune hemolytic anemia (AIHA) occurs when your immune system mistakes red blood cells for unwanted or foreign substances. Your body reacts by producing antibodies that destroy the red blood cells, causing anemia. Different factors may cause hemolytic anemia, including inherited conditions, infections and some medications.

Symptoms and Causes

What causes hemolytic anemia?

Hemolytic anemia may be caused by inherited conditions that affect the red blood cells. It’s also caused by certain infections or if someone receives a blood transfusion from a donor whose blood type didn’t match.

What inherited conditions can cause hemolytic anemia?

Some common inherited conditions are:

  • Sickle cell anemia: In this disease, your body produces abnormally shaped red blood cells that are trapped in small blood vessels, your spleen or liver.
  • Thalassemia: This is another group of inherited blood disorders that cause your body to make abnormal red blood cells that are easily destroyed.
  • G6PD deficiency: This genetic disorder affects an enzyme that protects red blood cells. When this enzyme level drops, blood cells exposed to certain infections or medications are likely to break apart.

What infections may cause hemolytic anemia?

Infections linked to hemolytic anemia include:

  • Malaria: This disease happens when mosquitos infected with tiny malaria parasites bite people, leaving parasites in people's bloodstreams. Left untreated, malaria can cause hemolytic anemia.
  • Rocky Mountain spotted fever: This infection spreads when ticks infected with the bacteria Rickettsia rickettsi bite people.
  • Haemophilus influenza disease: These are infections caused by the bacteria H. influenza.
  • Human immunodeficiency virus (HIV): This virus causes acquired immune deficiency syndrome (AIDS).

What medications may cause hemolytic anemia?

Some people develop hemolytic anemia from taking certain medications. Not everyone who takes these medications will develop hemolytic anemia. Your healthcare provider will review your medical history and current problems to be sure you can take these medications. These medications include:

  • Penicillin: This antibiotic treats infections and other serious medical problems.
  • Quinine: This medication treats malaria.
  • Methyldopa: This medication treats high blood pressure.
  • Sulfonamides: This is an anti-bacterial medication.

What are hemolytic anemia symptoms?

Hemolytic symptoms can be mild or more severe. They also can come on suddenly or develop over time. Typical symptoms include:

  • Jaundice: This condition affects your skin, the whites of your eyes (sclera) and your mucous membranes, causing them to turn yellow. This happens when you have a high level of bilirubin caused by a breakdown of your red blood cells.
  • Shortness of breath (dyspnea): This happens when you don’t have enough red blood cells carrying oxygen throughout your body.
  • Fatigue: Fatigue is a sensation of being so tired that it affects your daily life and your ability to do your daily activities.
  • Fast heartbeat (tachycardia): This condition means your heart is beating faster than it should. When your heart beats too fast, it doesn’t have enough time between beats to fill up with blood, and your heart can’t supply your body with the oxygen it needs.
  • Low blood pressure (hypotension): Low blood pressure can be a symptom or a condition. It happens when your blood pressure is much lower than expected.
  • Blood in your pee (hematuria): This can be a symptom of sickle cell disease.
  • Enlarged spleen or liver: Your liver and spleen filter red blood cells as the cells move through your body. Red blood cells that are damaged or dying are trapped by your spleen and liver, which destroy the cells. A larger-than-normal spleen or liver may be a sign your red blood cells are damaged.

Can anemia be a medical emergency?

Acute anemia may be a symptom of sudden and severe loss of blood or a sign that red blood cells are being destroyed very quickly. People who have acute anemia may have the following symptoms:

  • They’re very weak.
  • Their hearts are beating very hard and fast.
  • They have trouble catching their breath.

Diagnosis and Tests

How do you know if you have hemolytic anemia?

Healthcare providers diagnose hemolytic anemia by:

  • Asking about your medical history, specifically if your family members have anemia.
  • Asking if you have certain infections or are taking certain medications that may cause hemolytic anemia.
  • Doing a physical examination focused on anemia signs and symptoms, jaundice or if your spleen or liver is enlarged.

What tests do healthcare providers use to diagnose hemolytic anemia?

Healthcare providers typically use several blood tests to diagnose hemolytic anemia. They may also examine blood samples for genetic markers that may be signs of inherited conditions that cause hemolytic anemia. Typically, they’ll do preliminary blood tests to determine if your symptoms are caused by some form of anemia. A complete blood count (CBC) is one of the preliminary tests they may do. A CBC measures:

  • How many red blood cells, white blood cells and platelets you have.
  • The size of your red blood cells.
  • Hemoglobin, the protein in your blood that carries oxygen throughout your body.
  • Hematocrit, which measures the amount of space your red blood cells take in your blood.

What are the other tests healthcare providers may do?

They may order additional tests to identify the kind of anemia you may have. Here are tests that providers use to diagnose anemia, including hemolytic anemia:

  • Coombs test (direct antiglobulin test): This test checks for autoimmune hemolytic anemia.
  • Reticulocyte count: A reticulocyte count measures the number of immature red blood cells (reticulocytes) in your bone marrow. Healthcare providers measure reticulocytes to find out if your bone marrow is producing enough healthy red blood cells.
  • Haptoglobin test: Haptoglobin is a protein that eliminates debris produced by damaged red blood cells. Low haptoglobin levels may be a sign of damaged red blood cells.
  • Lactate dehydrogenase (LDH): LDH is an enzyme in red blood cells. A high LDH level may be a sign of increased red blood cell destruction.
  • Unconjugated bilirubin: When your red blood cells break down, they make bilirubin. This test measures the amount of bilirubin that’s not being processed by your liver. This is unconjugated bilirubin. A high unconjugated bilirubin level may be a sign that large numbers of red blood cells are being destroyed.
  • Peripheral blood smear: Healthcare providers examine blood cells for signs of abnormalities, including size and shape.
  • Hemoglobin electrophoresis: Healthcare providers use this test to analyze hemoglobin, a protein in your red blood cells that helps cells carry oxygen throughout your body.

Management and Treatment

How do healthcare providers treat hemolytic anemia?

Healthcare providers treat hemolytic anemia based on the cause of your illness and if you’re having severe symptoms. For example, if your healthcare provider believes you have severe anemia, they may order blood transfusions to stabilize your red blood cell count. Then they’ll diagnose the underlying condition that’s causing you to have anemia so they can treat the condition.

Prevention

How do I reduce my risk of developing hemolytic anemia?

Hemolytic anemia may be caused by several factors, most of which you can’t control. For example, you can develop hemolytic anemia after being injured, or by inheriting certain conditions. You can, however, reduce your risk for serious illness by talking to your healthcare provider any time you develop symptoms that may be anemia.

Outlook / Prognosis

What can I expect if I have hemolytic anemia?

Hemolytic anemia affects people in different ways. Sometimes, hemolytic anemia is a symptom of an underlying serious medical condition that requires extensive treatment. Other times, hemolytic anemia happens as a reaction to certain infections and medications. In those cases, healthcare providers cure the condition by treating the underlying infection or changing medications.

Living With

How do I take care of myself?

Healthcare providers may be able to cure your hemolytic anemia. Once you’re feeling better, you may be interested in learning how to manage your health to avoid another bout of illness. Some suggestions that may help you to manage anemia include:

  • Follow a healthy diet rich in vitamins B12, C and B9 (folic acid). Ask to speak to a nutritionist if you’d like more information on ways to keep your red blood cells strong.
  • Drink enough water to stay hydrated.
  • Get regular exercise. Check with your healthcare provider about ways to exercise safely.
  • Avoid infections by washing your hands and avoiding people when they’re sick.
  • Keep track of your symptoms by writing them down.
  • Talk to your doctor about any changing symptoms.

A note from Cleveland Clinic

Hemolytic anemia happens when something is destroying your red blood cells. This condition may be a sign you have an inherited medical condition or a medical issue caused by infection. You may be reacting to specific medications. Regardless of the cause, your healthcare provider will focus on finding and treating the underlying cause. Prompt treatment often makes the difference between getting well and getting worse. Hemolytic anemia symptoms may look and feel like less serious conditions. You know your body best, including how long it takes you to recover from everyday illnesses. Talk to your healthcare provider whenever you’re concerned about changes in your body that don’t go away.

Last reviewed by a Cleveland Clinic medical professional on 03/03/2022.

References

  • Alder Laura, Tambe AJ. Acute Anemia. (https://www.ncbi.nlm.nih.gov/books/NBK537232/#_NBK537232_pubdet_) StatPearls. Accessed 3/3/2022.
  • American Family Physician. Hemolytic Anemia: Evaluation and Differential Diagnosis. (https://www.aafp.org/afp/2018/0915/p354.html) Accessed 3/3/2022.
  • Baldwin Caitlyn, Pandey Jyotsna, Olarewaju Olubunmi. Hemolytic Anemia. StatPearls. (https://www.ncbi.nlm.nih.gov/books/NBK558904/#_NBK558904_pubdet_) Accessed 3/3/2022.
  • Merck Manual. Overview of Anemia. (https://www.merckmanuals.com/home/blood-disorders/anemia/overview-of-anemia?query=hemolytic%2520anemia) Accessed 3/3/2022.
  • National Organization of Rare Diseases. Anemia, Hemolytic, Acquired Autoimmune. (https://rarediseases.org/rare-diseases/anemia-hemolytic-acquired-autoimmune/) Accessed 3/3/2022.
  • Thiagarajan Perumal, Parker Charles J, Prchal Josef T. How Do Red Blood Cells Die? (https://www.frontiersin.org/articles/10.3389/fphys.2021.655393/full#S10) Frontiers in Physiology. Accessed 3/3/2022.

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