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Hemolytic anemia: Premature destruction of red blood cells

Hemolytic anemia is a form of anemia in which red blood cells are prematurely destroyed and removed from the bloodstream. The destruction of red blood cells is due to many possible causes such as diseases and environmental factors. The symptoms vary widely, but some symptoms include confusion, difficulty concentrating, dark urine and fever. In mild hemolytic anemia, the patient does not require any treatment, but a severe form of the blood disorder requires prompt and proper treatment. Medication, surgery or a blood transfusion are the most common treatments . The prospects are very different.

  • Epidemiology blood disorder
  • Functioning of the body in hemolytic anemia
  • Causes of premature breakdown of red blood cells
  • Symptoms
  • Diagnosis and examinations
  • Treatment of anemia
  • Prognosis depends on cause


Epidemiology blood disorder

Hemolytic anemia represents approximately 5% of all forms of anemia (deficiency of red blood cells: anemia). Hemolytic anemia has no racial predilection, but this is often the case with the underlying cause. An example of this is sickle cell anemia, which mainly affects Africans, African Americans, some Arab peoples, and Aboriginal peoples in southern India. The blood disorder has no sexual predilection for most causes. Although hemolytic anemia is possible at any age, symptoms in hereditary conditions are usually apparent from birth, while in acquired conditions they develop later in life.

Functioning of the body in hemolytic anemia

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells deliver oxygen to body tissues. Under normal conditions, red blood cells remain in the body for about 120 days. In anemia, the red blood cells in the blood are broken down prematurely. The bone marrow is largely responsible for the production of new red blood cells. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. Hemolytic anemia occurs when the bone marrow does not produce enough red cells to replace the destroyed red blood cells.

Causes of premature breakdown of red blood cells

Hemolytic anemia has several possible causes, although the blood disorder does not have a known cause for everyone. The destruction of red blood cells occurs by, for example:

  • blood clots in the small blood vessels
  • typhoid fever (bacterial infection with fever and abdominal pain)
  • chronic lymphocytic leukemia
  • exposure to certain chemicals such as arsenic (arsenicum ) and lead (lead poisoning)
  • exposure to certain toxins
  • an autoimmune condition in which the immune system mistakenly mistakes red blood cells as foreign substances and subsequently destroys them (lupus, rheumatoid arthritis (chronic autoimmune condition with inflammation of joints and other organs), etc.)
  • a bone marrow or stem cell transplant
  • a blood transfusion from a donor with a blood group that does not match that of the patient
  • an HIV infection
  • an infection
  • an artificial device in the body such as a heart valve
  • a non-Hodgkin lymphoma (cancer in lymphocytes of the immune system with swollen lymph nodes and general symptoms)
  • an inflammation of the liver (hepatitis)
  • an organ transplant
  • a tumor
  • an enlargement of the spleen (splenomegaly)
  • Escherichia coli
  • genetic defects in red cells (such as sickle cell anemia, thalassemia and Glucose-6-phosphate dehydrogenase (G6PD) deficiency)
  • the cytomegalovirus
  • the Epstein-Barr virus (glandular fever: viral infection with sore throat, swollen lymph nodes, fatigue and mild fever that mainly occurs in adolescents and young adults)
  • the use of medicines (including antibiotics, malaria tablets, paracetamol)
  • Evans syndrome (destruction of blood cells and platelets)
  • the Wiskott-Aldrich syndrome (blood clotting and skin problems)
  • Mycoplasma pneumonia
  • Streptococcus



With hemolytic anemia, symptoms occur at birth or later in life. The symptoms also develop suddenly or gradually. In addition, symptoms range from mild to severe. With mild symptoms, no symptoms occur. Other symptoms include:

  • concentration problems and thinking problems
  • dark urine
  • dizziness (especially upon waking)
  • pale skin
  • a sore tongue (tongue pain)
  • an enlarged liver (hepatomegaly)
  • an enlarged spleen (splenomegaly)
  • an increased heart rate (tachycardia)
  • jaundice of the skin and whites of the eyes) (medical term: icterus)
  • heart murmur
  • headache and morning headache
  • fever
  • shortness of breath
  • pain in the upper abdomen
  • fatigue
  • confusion
  • weakness


Diagnosis and examinations

Physical examination

During the physical examination, yellow discolored skin may be visible. When palpating the patient, the doctor notices the enlarged liver and/or spleen. The doctor listens to the heart through auscultation and notices a fast or irregular heartbeat. The doctor also listens to the patient’s breathing sounds and notes that breathing is also rapid or irregular.

Diagnostic research

The doctor performs a complete blood test which reveals the anemia. Hypophosphatemia (decreased phosphate levels in the blood) may also be present. This also provides information about the nature and cause of the condition. A urinalysis, a bone marrow puncture or a biopsy are also useful diagnostic tests.

Treatment of anemia

The treatment depends on the nature and cause of the hemolytic anemia: In emergencies, a blood transfusion is sometimes necessary. When the patient has an overactive immune system, immune suppressing medications, better known as immunosuppressants, help. Bone marrow stimulating drugs (growth factor drugs) help the bone marrow produce new red and white blood cells and platelets. Extra folic acid and iron supplements are needed when blood cells are being destroyed at a rapid rate. Corticosteroids and intravenous immunoglobulins are medications that the doctor uses for some conditions. In rare cases, surgery to remove the spleen (splenectomy) is necessary. The spleen filters the abnormal cells from the blood.

Prognosis depends on cause

The prognosis for patients with hemolytic anemia depends on the underlying cause. Mortality rates are often low, but the risk of death is greater in older patients and patients with poor heart and kidney function. Severe anemia may cause cardiovascular and pulmonary disease, or worsen cerebrovascular disease.

read more

  • Anemia (deficiency of red blood cells): Types and causes
  • Anemia (anemia): Types of red blood cell deficiency
  • Hemolytic disease of the newborn: Condition in infant
  • Anemia (anemia) during pregnancy