What is hemolytic anemia?

Related conditions:
Lymphoproliferative disorders such as chronic lymphocytic leukemia, lymphoma, multiple myeloma, and thymoma. May be seen in patients with carcinoma of the breast or stomach as well as cancers of the colon, prostate, lung, cervix, and pancreas. Also seen in patients with hepatitis, cytomegalovirus, or streptococcus.

Definition:
Hemolytic anemia occurs when there are too few red blood cells in the body as a result of premature destruction of red blood cells. Destruction occurs more quickly than the bone marrow can produce new cells.

Risk factors: Patients receiving chemotherapy or radiation for the treatment of a lymphoproliferative disease or solid tumors of the breast, stomach, colon, prostate, lung, cervix, or pancreas are at risk for developing hemolytic anemia. Also at risk are people suffering with an infection, such as hepatitis, cytomegalovirus, or streptococcus, or those taking penicillin, sulfa drugs, or large quantities of acetaminophen. People diagnosed with autoimmune disorders, lupus, rheumatoid arthritis, or ulcerative colitis can also be at risk.

Etiology and the disease process: This destruction of red blood cells, or hemolysis, falls into two groups: intrinsic and extrinsic. Intrinsic refers to the destruction of the red blood cells due to a defect within the cells themselves. Intrinsic hemolysis is caused by an inherited condition such as sickle cell anemia or thalassemia, which cause red blood cells to have a shorter life span than normal. Extrinsic refers to red blood cells that develop in a healthful manner but then are destroyed by infection or drugs. Extrinsic hemolysis can be temporary and resolve over several months.

Incidence: Some 20 percent of hemolytic anemias are caused by lymphocytic leukemia, 10 percent are the result of an autoimmune disease, and all others are related to medications. Women are twice as likely to contract hemolytic anemia as are men. One in 80,000 cases of anemia is hemolytic anemia.

Symptoms: Symptoms of hemolytic anemia include pale skin, a yellowing of the skin or eyes, dark urine, fever, weakness, dizziness, confusion, inability to tolerate physical activity, an enlarged spleen and liver, rapid heart rate, or heart murmur.

Screening and diagnosis: Hemolytic anemia is found when a patient visits the physician’s office with complaints of tiring easily, dizziness, or paleness of the skin. The physician will order laboratory tests to monitor the patient’s red blood cell count. Laboratory tests include tests for hemoglobin levels, reticulocyte counts, liver function tests, and, in more serious conditions, a bone marrow aspiration and biopsy. A urine sample may be needed to evaluate for increased proteins or hemoglobin.

Treatment and therapy: Treatment is based on the patient’s overall condition and type of anemia. The patient’s age, medical history, cause of disease, and ability to tolerate treatment are considered. Treatment includes blood transfusions, steroid medications, and infusions of immune globulins to strengthen the immune system. More severe cases are treated with surgical removal of the spleen or immunosuppressive therapy.

Prognosis, prevention, and outcomes: There is no known prevention for intrinsic hemolytic anemia. Extrinsic hemolytic anemia can be prevented by avoiding the use of medications that may cause anemia. Mild cases may not need treatment, whereas severe cases can be life-threatening. An inherited form of anemia will require lifelong treatment.

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