Hemolytic anemia is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over. Red blood cells are disc-shaped and look like doughnuts without holes in the center. These cells carry oxygen throughout the body. They also remove carbon dioxide (a waste product) from your body. Red blood cells are made in the bone marrow—a sponge-like tissue inside the bones. They live for about 120 days in the bloodstream and then die. White blood cells and platelets (PLATE-lets) also are made in the bone marrow. White blood cells help fight infections. Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding. When blood cells die, the body’s bone marrow makes more blood cells to replace them. However, in hemolytic anemia, the bone marrow can’t make red blood cells fast enough to meet the body’s needs. Hemolytic anemia can lead to many health problems, such as fatigue (tiredness), pain, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, and heart failure.
Overview
Hemolytic anemia is a type of anemia. The term “anemia” usually refers to a condition in which the blood has a lower than normal number of red blood cells. Anemia also can occur when the red blood cells don’t contain enough hemoglobin . Hemoglobin is an iron-rich protein that carries oxygen from the lungs to the rest of the body. Types of Hemolytic Anemia There are many types of hemolytic anemia. The condition can be inherited or acquired. Inherited Hemolytic Anemias With inherited hemolytic anemias, one or more of the genes that control red blood cell production are faulty. This can lead to problems with the hemoglobin, cell membrane, or enzymes that maintain healthy red blood cells. The abnormal cells may be fragile and break down while moving through the bloodstream. If this happens, the spleen may remove the cell debris from the bloodstream.
Sickle Cell Anemia
Sickle cell anemia is a serious, inherited disease. In this disease, the body makes abnormal hemoglobin. This causes the red blood cells to have a sickle, or crescent, shape. Sickle cells don’t last as long as healthy red blood cells. They usually die after only about 10 to 20 days. The bone marrow can’t make new red blood cells fast enough to replace the dying ones. In the United States, sickle cell anemia mainly affects African Americans.
Thalassemias
Thalassemias are inherited blood disorders in which the body doesn’t make enough of certain types of hemoglobin. This causes the body to make fewer healthy red blood cells than normal. Thalassemias most often affect people of Southeast Asian, Indian, Chinese, Filipino, Mediterranean, or African origin or descent.
Hereditary Spherocytosis
In this condition, a defect in the surface membrane (the outer covering) of red blood cells causes them to have a sphere, or ball-like, shape. These blood cells have a lifespan that’s shorter than normal. Hereditary spherocytosis is the most common cause of hemolytic anemia among people of Northern European descent.
Hereditary Elliptocytosis (Ovalocytosis)
Like hereditary spherocytosis, this condition also involves a problem with the cell membrane. In this condition, the red blood cells are elliptic (oval) in shape. They aren’t as flexible as normal red blood cells, and they have a shorter lifespan.
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
In G6PD deficiency, the red blood cells are missing an important enzyme called G6PD. G6PD is part of the normal chemistry inside red blood cells. In G6PD deficiency, if red blood cells come into contact with certain substances in the bloodstream, the missing enzyme causes the cells to rupture and die. Many factors can trigger the breakdown of the red blood cells. Examples include taking sulfa or antimalarial medicines; being exposed to naphthalene, a substance found in some moth balls; eating fava beans; or having an infection. G6PD deficiency mostly affects males of African or Mediterranean descent. In the United States, the condition is more common among African Americans than Caucasians.
Pyruvate Kinase Deficiency
In this condition, the body is missing an enzyme called pyruvate (PI-ru-vate) kinase. Not having enough of this enzyme causes red blood cells to break down easily. This disorder is more common among the Amish than other groups.
Acquired Hemolytic Anemias
With acquired hemolytic anemias, red blood cells may be normal. However, some other disease or factor causes the body to destroy red blood cells and remove them from the bloodstream. The destruction of the red blood cells occurs in the bloodstream or, more commonly, in the spleen.
Immune Hemolytic Anemia
In immune hemolytic anemia, your immune system destroys the red blood cells. The three main types of immune hemolytic anemia are autoimmune, alloimmune, and drug-induced.
Autoimmune hemolytic anemia (AIHA).
In this condition, the immune system makes antibodies (proteins) that attack the red blood cells. Why this happens isn’t known. Autoimmune hemolytic anemia accounts for half of all cases of hemolytic anemia. Autoimmune hemolytic anemia may come on very quickly and become serious. Having certain diseases or infections can raise the risk for AIHA. Examples include:
- Autoimmune diseases, such as lupus
- Chronic lymphocytic leukemia
- Non-Hodgkin’s lymphoma and other blood cancers
- Epstein-Barr virus
- Cytomegalovirus
- Mycoplasma pneumonia
- Hepatitis HIV
Autoimmune hemolytic anemia also can develop after you have a blood and marrow stem cell transplant. In some types of AIHA, the antibodies made by the body are called warm antibodies which destroy red blood cells at warm temperatures, such as body temperature. In other types of AIHA, the body makes cold-reactive antibodies. These antibodies are active at cold temperatures. Cold-reactive antibodies can become active when parts of the body, such as the hands or feet, are exposed to temperatures lower than 32 to 50 degrees Fahrenheit (0 to 10 degrees Celsius). Warm antibody AIHA is more common than cold antibody AIHA.
Alloimmune hemolytic anemia
This type of hemolytic anemia occurs when the body makes antibodies against red blood cells received in a blood transfusion. This can happen if the transfused blood is a different blood type than the patient’s blood. This type of hemolytic anemia also can occur during pregnancy if a woman has Rh-negative blood and her baby has Rh-positive blood.
Drug-induced hemolytic anemia
Certain medicines can cause a reaction that develops into hemolytic anemia. Some medicines, such as penicillin, bind to red blood cell surfaces and can cause antibodies to develop. Other medicines cause hemolytic anemia in other ways. Examples of these medicines include chemotherapy, acetaminophen, quinine and antimalarial medicines, anti-inflammatory medicines, and levodopa.
References:
Hemolytic Anemia. Retrieved from https://www.nhlbi.nih.gov/health-topics/hemolytic-anemia.
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