Hemolytic anemia: symptoms, causes and treatment

Definition

What is hemolytic anemia?

Hemolytic anemia is a type of anemia that occurs when red blood cells are destroyed or die sooner than they should. As a result, your body lacks healthy red blood cells.

When the body lacks healthy red blood cells, various health problems may arise, such as pain, irregular heartbeats (arrhythmias), an enlarged heart, and heart failure.

Red blood cells contain hemoglobin which functions to transport oxygen. Patients with hemolytic anemia tend to tire easily because their bodies do not receive sufficient oxygen intake because they are deficient in red blood cells. As a result, some of the body's organs do not function properly.

Signs and symptoms

What are the signs and symptoms of hemolytic anemia?

Symptoms of anemia vary, depending on the type. People who have this type of anemia can experience different symptoms.

However, there are some common symptoms that many people experience when they have hemolytic anemia, such as:

1. Jaundice (jaundice)

Jaundice refers to the yellowish color that occurs on the skin or the whites of the eyes. When red blood cells die, they release hemoglobin into the bloodstream.

Hemoglobin is broken down into a compound called bilirubin which causes yellowish skin and eyes. Bilirubin also causes urine to turn dark yellow or brown.

2. Pain in the upper abdomen

High levels of bilirubin and cholesterol (from the breakdown of red blood cells) can form stones in the gallbladder. These gallstones can cause pain in the upper abdomen.

Not only that, pain can also arise due to an enlarged spleen. The spleen is an organ in the stomach that helps fight infection and filters old or damaged blood cells. In this condition, the spleen can become enlarged and can be painful.

3. Foot ulcers and leg pain

Sickle cell anemia is a type of hemolytic anemia. This abnormal shape of blood cells can block small blood vessels and blood flow. This can cause sores to the feet and pain throughout the body.

Less common signs and symptoms that appear in patients with other hemolytic anemia include:

• Dark urine
• Yellowing of the skin and the whites of the eyes (jaundice)
• Heart murmur
• Increased heart rate
• Enlarged spleen
• Enlarged liver

Cause

What causes hemolytic anemia?

The cause of hemolytic anemia is the death or destruction of red blood cells faster than they should. Normally, red blood cells will be destroyed within 120 days of being produced.

The causes of hemolytic anemia are not always known. However, there are many factors that cause the body to destroy red blood cells more quickly, such as disease, medication side effects, or other environmental factors.

However, in general, this faster destruction of red blood cells can occur due to two things, namely genetic factors (heredity) and acquired during life.

1.Genetic hemolytic anemia (hereditary)

If your anemia has something to do with problems with hemoglobin, cell membranes, or enzymes that keep your red blood cells healthy, it could be genetic.

This type of anemia is often triggered due to faulty genes that control red blood production. When moving through the bloodstream, the red blood cells can become abnormally shaped, brittle and damaged.

Hemolytic anemia due to heredity is further divided into five types, namely:

• Sickle cell anemia
• Thalassemia
• Hereditary spherocytosis
• Hereditary elliptocytosis (Ovalocytosis)
• Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
• Pyruvate Kinase deficiency

2. Undersigned hemolytic anemia

Apart from heredity, hemolytic anemia can also be acquired and developed during life (acquired).

At first, your red blood cells may be normal and healthy. However, some diseases or other factors cause your body to destroy its own red blood cells leading to anemia.

Types of hemolytic anemia that are not inherited include:

• Autoimmune Hemolytic Anemia (AIHA)
• Alloimmune Hemolytic Anemia (AHA)

3. Hemolytic anemia due to drug side effects

Hemolytic anemia can also occur as a side effect of drugs. This condition occurs when a drug triggers your immune system to attack its own red blood cells.

Chemicals in drugs (such as penicillin) can stick to the surface of red blood cells and cause development or changes in antibodies.

The following types of hemolytic anemia due to side effects of drugs:

• Mechanical Hemolytic Anemia
• Paroxysmal Nocturnal Hemoglobinuria (PNH)

Apart from those mentioned above, this condition can also occur due to blood transfusions. This can happen if the donor's blood type is different from yours.

Signs and symptoms of a severe reaction to a blood transfusion include fever, chills, low blood pressure, and shock.

Risk Factors

What are the factors that increase my risk of having this condition?

The main risk factors for the main causes of hemolytic anemia are kheredity or genetics.

Patients with genetic due to hemolytic anemia have defects in the genes that control the production of red blood cells. This defective gene is passed down from one or both parents.

This defective gene can occur in any gene, such as hemoglobin, cell membranes, or an enzyme that maintains healthy red blood cells (G6PD).

Not only heredity, several conditions put you at risk for hemolytic anemia, including:

• Immune system disorders (autoimmune)
• Infection
• Reactions to drugs or blood transfusions
• Hypersplenism

Diagnosis

How to diagnose this condition?

Many tests are used to diagnose hemolytic anemia. These tests can help diagnose, find the cause, and find out how severe the anemia is.

1. Complete Blood Count (CBC)

In many cases, the initial test used to diagnose anemia is complete blood count aka complete blood test. If these tests show anemia, you may need further tests to find out the type and severity of anemia you have.

2. Count the reticulocytes

Reticulocyte count is useful for measuring the number of pink blood cells in your blood. This test is useful for assessing the work of the bone marrow in making red blood cells normally.

People with hemolytic anemia usually have a high reticulocyte count because their bone marrow works hard to replace destroyed red blood cells.

3. Peripheral smear

For this test, your doctor will examine the red blood cells through a microscope because some types of hemolytic anemia have an abnormal shape of the blood cells.

4. Coombs' test

This test can show whether or not antibodies are made by the body to destroy red blood cells.

5. Haptoglobin, bilirubin, and liver function tests

When broken, red blood cells release hemoglobin into the bloodstream. Hemoglobin combines with a chemical called haptoglobin. Low levels of haptoglobin in the blood are a sign of hemolytic anemia.

Hemoglobin is also broken down into a compound called bilirubin. High levels of bilirubin in the blood may be a sign of hemolytic anemia.

High bilirubin can also occur due to liver and gallbladder disease. You may need liver function tests to find out what is causing the high levels of bilirubin in your body.

6. Hemoglobin electrophoresis

Electrophoretic hemoglobin is especially useful for checking various types of hemoglobin in the blood. This can help diagnose the type of anemia you have.

7.Test for paroxysmal nocturnal hemoglobinuria (PNH)

This test is used to detect red blood cells that are missing certain proteins.

8. Osmotic fragility test

This test is done to look for red blood cells that are more fragile than normal red blood cells. These cells may be a sign hereditary spherocytosis (a type of hereditary hemolytic anemia).

9. G6PD deficiency test

In cases of G6PD deficiency, red blood cells lose an important enzyme called G6PD (glucose-6-phosphate dehydrogenase). This test is used to look for missing enzymes in a blood sample.

10. Urine test

A urine test will detect the presence of free hemoglobin (a protein that carries oxygen in the blood) and iron.

11. Bone marrow examination

This test shows the performance of healthy bone marrow in making enough blood cells. The bone marrow test is divided into two, namely aspiration and biopsy.

In a bone marrow aspiration, the doctor will take a small amount of bone marrow fluid through a needle. The sample is examined under a microscope to check for damaged cells.

Meanwhile, a bone marrow biopsy can be done simultaneously or after an aspiration. Usually, the doctor will take a small amount of bone marrow tissue through a needle. The tissue sample is examined for the number and types of cells in the bone marrow.

You may not need to have a bone marrow test if blood tests have shown a cause of hemolytic anemia.

12. Other tests to find the cause of anemia

Anemia is a blood deficiency condition with a specific cause, you may be tested for conditions such as:

• Kidney failure
• Lead poisoning
• Lack of vitamins or iron

Treatment

How to treat and treat hemolytic anemia?

Excerpted from the U.S. website. The National Library of Medicine, treatment options for this type of anemia vary depending on the cause, severity of the condition, your age, your health, and your body's tolerance for certain drugs.

However, in general, hemolytic anemia treatment aims to:

• Reduce or stop red blood cell destruction
• Increase the number of red blood cells to normal levels
• Treat the underlying causes of hemolytic anemia
• Prevent complications due to anemia

Some of the treatment options for hemolytic anemia include:

1. Blood transfusions

Blood transfusions are performed to treat severe or life-threatening hemolytic anemia. A red blood cell transfusion is given to increase your red blood cell count rapidly and to replace the destroyed red blood cells with new ones.

2. Intravenous immunoglobulin

You may be given liquid immunoglobulin drugs intravenously or intravenously in the hospital. Its function is to partially weaken the immune system if your lack of blood leads to autoimmune hemolytic anemia.

3. Take corticosteroid drugs

In the case of hemolytic anemia due to autoimmune disease, you may be given a corticosteroid medication. This anemia medication can reduce the activity of your immune system and help prevent red blood cells from being destroyed more quickly.

4. Bone marrow transplant

In some types of hemolytic anemia, such as thalassemia, the bone marrow cannot make enough healthy red blood cells. That is why, a blood cell and bone marrow transplant may be needed (stem cells).

5. Plasmapheresis

Plasmapheresis is a procedure for removing and replacing antibodies from the blood. In this procedure, blood is drawn from the body using a needle that is inserted into a vein.

The plasma which contains antibodies will be separated from the blood. The plasma from the donor and the rest of the blood is put back in your body.

This treatment can be undertaken if other treatments do not show promising results.

6. Operations

In severe cases of hemolytic anemia, your spleen may need to be removed. The spleen is where red blood cells are destroyed. Removing the spleen can help reduce the speed at which the body breaks down red blood cells.

It is usually used as an option in autoimmune hemolytic cases. Surgery can also be performed if corticosteroid drugs or other immunosuppressants do not work.

Prevention

How can you prevent and treat this condition at home?

Basically, this type of anemia cannot be prevented, especially because it is caused by heredity.

You can help prevent anemia by eating a balanced diet that includes good sources of iron, vitamin B12 and folate.

Apart from that, you can perform other tips including:

• If you are a vegetarian, ask your doctor or nutritionist for supplements or vitamin C that can help your body absorb more iron from food.
• Limit or drink less caffeinated beverages.
• Choose fortified or iron-fortified cereals and breads.
• Take precautions if you work in a radiant environment such as in a battery, paint, or petroleum mine.
• Check your health condition regularly to monitor your anemia symptoms.