Hemolytic Anemia

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is hemolytic anemia?

Hemolytic anemia is a serious yet treatable blood disorder. It occurs when the body destroys red blood cells faster than it can make new ones. Red blood cells are responsible for carrying oxygen to all the body’s cells and tissues. When their destruction outpaces their production, the number of red blood cells in the blood falls too low. This results in anemia—a condition where there are not enough red blood cells to carry adequate oxygen to the body.

Normally, a red blood cell lives for about 120 days. The body gets rid of old red blood cells through a process called hemolysis. It replaces the old ones with new ones through a process called erythropoiesis. In hemolytic anemia, hemolysis happens too early. This shortens the lifespan of red blood cells to less than 120 days.

There can be several causes for the premature destruction of red blood cells. In general, doctors classify hemolytic anemia as inherited or acquired. Inherited causes include sickle cell disease and G6PD (glucose-6-phosphate dehydrogenase) deficiency. Acquired causes include autoimmune reactions and infections. Having a family history of hemolytic anemia or any condition that could lead to it increases your risk of developing it.

Hemolytic anemia can be acute or chronic. It can also range from mild to severe. With mild, chronic disease, you may not have any symptoms. However, acute or severe hemolytic anemia causes symptoms in most cases. This includes feeling weak or tired, dizziness, headache, heart palpitations, and pale skin. You may also have jaundice and dark urine.

Hemolytic anemia treatment depends on the underlying cause. Blood transfusions may be necessary to quickly replenish red blood cells. In severe cases, surgery to remove an overactive spleen can be an option.

Seek prompt medical care if you have symptoms of anemia. There can be other causes of symptoms such as fatigue. It’s important to get an accurate diagnosis as quickly as possible to address the underlying problem.

What are the symptoms of hemolytic anemia?

You may or may not have symptoms right away with hemolytic anemia. Some people go quite some time without realizing there is a problem. When symptoms occur, they can happen suddenly or develop slowly with time. It largely depends on the underlying cause of hemolysis.

Common symptoms of hemolytic anemia

Common hemolytic anemia symptoms and signs include:

  • Fatigue, tiredness and weakness

  • Headache, confusion and dizziness

  • Heart palpitations and shortness of breath

  • Liver or spleen enlargement

  • Pale skin and dark urine

  • Yellowing of the skin and eyes (jaundice)

Serious symptoms that might indicate a serious or life-threatening condition

In some cases, hemolytic anemia can be serious and lead to life-threatening complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

If you have a hemolytic anemia diagnosis, you will need regular follow-up care. This may be temporary or long-term depending on the cause.

What causes hemolytic anemia?

Hemolytic can be either inherited or acquired. In inherited disease, you are born with a genetic abnormality. Genetic causes include sickle cell disease, G6PD deficiency, PK (pyruvate kinase) deficiency, and thalassemia.

You are not born with an acquired disease. Instead, you develop it later in life. Possible acquired causes of hemolytic anemia include autoimmune disorders, bone marrow failure, infections, blood cancers, tumors, trauma, heart valves, and an overactive spleen. (The spleen is where hemolysis occurs.) Hemolytic anemia can also be a side effect of certain medications and blood transfusions, when the blood type is mismatched.

What are the risk factors for hemolytic anemia?

Risk factors for hemolytic anemia are related to the cause. Having a genetic disorder known to cause hemolytic anemia puts you at risk for the condition. However, it is not always possible to predict when causes, such as infection, will lead to hemolytic anemia.

Reducing your risk of hemolytic anemia

Preventing hemolytic anemia depends on the underlying cause. Some examples include:

  • Careful matching between the donor and recipient can prevent blood transfusion reactions.

  • People with G6PD deficiency can reduce their risk by avoiding triggering substances.

  • People with a previous reaction to a drug should avoid that drug in the future.

If you are at risk for hemolytic anemia or have had it in the past, talk with your doctor. Ask about ways to avoid possible triggers and keep yourself healthy.

How is hemolytic anemia treated?

Hemolytic anemia treatment depends on the severity of the disease and the underlying cause. If the anemia is mild and the body can compensate, treatment may not be necessary.

Doctors will address any treatable causes, such as infection and drug side effects, with appropriate treatment. For immune-related disease, treatment involves drugs to control the immune response. Blood transfusions may be necessary to quickly replenish the body’s red blood cell supply. Folic acid will support new red blood cell production. In severe cases, surgery to remove the spleen may be necessary. The spleen is the main site of red blood cell destruction.

What are the potential complications of hemolytic anemia?

Severe cases of hemolytic anemia can lead to serious complications. This includes heart arrhythmias, heart muscle disease (cardiomyopathy), and heart failure. It can also worsen existing heart disease, lung disease, and cerebrovascular disease. Seeking prompt treatment is the best way to prevent complications.

Hemolytic anemia can be a one-time occurrence. It may go away and never come back, depending on the cause. However, some causes lead to ongoing problems with hemolysis. A hematologist—a doctor who specializes in blood disorders—can help you understand your future medical needs.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 11
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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