Hemolytic anemia

Hemolytic anemia: Description, Causes and Risk Factors: Abbreviation: HA. Hemolytic anemiaHemolytic anemia is a diverse group of clinical disorders characterized by decreased survival of erythrocytes (A mature blood cell that contains hemoglobin to carry oxygen to the bodily tissues; a biconcave disc that has no nucleus) in the circulation. Because of their multiple causes, hemolytic anemias are often difficult for hematologists, as well as internists and primary care physicians, to diagnose. Causes and Risk Factors:
  • Hemolytic anemia can either be acquired or inherited. A genetic abnormality in the red blood cells is the underlying cause in the inherited cases. Anemia in the inherited cases occurs early in life. It includes thalassemia, sickle cell anemia, and spherocytosis (a condition in which the shape of the red blood cells is spherical instead of the normal doughnut-shape).
  • People who have an inherited deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), risk developing hemolytic anemia if the use certain medications like antimalarial drugs, antibiotics and methyldopa (used to treat hypertension).
  • Infections such as hepatitis, cytomegalovirus, Epstein-Barr virus, typhoid fever, streptococcus, or Escherichia coli (E. coli).
  • Hemolytic anemia due to another form of G6PD deficiency, which is common in the Greek isles, results from eating fava beans or inhaling its pollens.
  • Some infectious diseases like malaria are known to destroy the red blood cells.
  • Leukemia or lymphoma.
  • TTP - Thrombotic thrombocytopenic purpura - Platelet aggregation on the microvascular endothelium.
  • Family history of hemolytic anemia.
  • Artificial heart valves, blood clots, or the abnormalities in the lining of the blood vessels can cause mechanical damage leading to the destruction of red blood cells.
Many factors may put you at risk for developing hemolytic anemia. For instance, an infection can compromise your immune system and affect your body's ability to produce new red blood cells (RBCs). Certain medications may also trigger a case of hemolytic anemia, so you will need to check with your doctor to see whether there is a connection. Autoimmune disorders such as Type 1 diabetes, rheumatoid arthritis, lupus, dermatomyositis, multiple sclerosis (MS), Graves' disease, and Addison's disease may also increase the likelihood for developing hemolytic anemia. Symptoms: Symptoms may include the following:
  • Fever and chills.
  • Dark urine.
  • Enlarged spleen.
  • Fatigue.
  • Pale skin color (pallor).
  • Rapid heart rate (tachycardia).
  • Shortness of breath (SOB).
  • Yellow skin color (jaundice).
Diagnosis: Once you notice the common symptoms of hemolytic anemia, you should see a physician immediately. Your doctor will first take a blood sample to determine whether hemolysis, or the destruction of red blood cells, is evident. Once hemolysis is identified, you doctor will then schedule further tests to screen your urine for hemoglobin, hemosiderin, low serum haptoglobin and a low red blood cell count. Additional tests may be used to identify hemolytic anemia and to isolate this condition from other types of anemia or blood disorders. These procedures include platelet tests, potassium tests and uric acid tests, among others. Finally, your doctor may feel your abdomen to see whether your spleen is enlarged. Chest x-ray and ECG may be needed to assess cardiopulmonary status. Other Tests:
  • Coombs test: The direct Coombs test is used clinically when immune-mediated hemolytic anemia (antibody-mediated destruction of RBCs) is suspected.
  • Cold agglutinins: A high titre of anti-I antibody may be found in mycoplasma infections and a high titre of anti-I antibody may be found in hemolysis associated with infectious mononucleosis. An anti-P cold agglutinin may be seen in paroxysmal cold hemoglobinuria.
Treatment: Treatment depends on the type and cause of the hemolytic anemia. Options for hemolytic anemia treatment include:
  • Iron therapy: This is indicated for patients with severe intravascular hemolysis in which persistent hemoglobinuria has caused substantial iron loss. Iron stores increase in hemolysis and so iron administration is generally contraindicated in hemolytic disorders, particularly those that require chronic transfusion support.
  • Immunosuppressant drugs may be given to treat hemolytic anemia if it is caused by an autoimmune disorder.
  • Corticosteroid drugs, such as prednisone, may help prevent the destruction of red blood cells.
  • Anemia caused by hereditary spherocytosis can be greatly improved if the patient gets his/her spleen removed because the spleen is the main site of the destruction of red blood cells.
  • Administer folic acid because active hemolysis may cause folate deficiency. Discontinue medications that may have precipitated or aggravated hemolysis.
  • Transfusion Therapy: Avoid transfusions unless absolutely necessary, but they may be essential. In autoimmune hemolytic anaemia, type matching and cross matching may be difficult. Use the least incompatible blood if transfusions are indicated. The risk of acute haemolysis of transfused blood is high, but the degree is dependent on the rate of infusion.
  • Finally, bone marrow transplants are recommended in severe forms of acquired hemolytic anemia.
Note: Avoid cold temperatures. Cold temperatures can result in premature breakdown of blood cells. Protect your hands and feet from exposure to cold using gloves and stockings. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  


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