 Hemolytic Anemia
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Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than the bone marrow can produce them. The term for destruction of red blood cells is hemolysis. There are two types of hemolytic anemia:
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- intrinsic - the destruction of the red blood cells due to a defect within the red blood cells themselves. Intrinsic hemolytic anemias are often inherited, such as sickle cell anemia and thalassemia. These conditions produce red blood cells that do not live as long as normal red blood cells.
- extrinsic - red blood cells are produced healthy but are later destroyed by getting trapped in the spleen, destroyed by infection, or destroyed from drugs that can affect red blood cells. The following lists some of the causes of extrinsic hemolytic anemia, also called autoimmune hemolytic anemia:
- infections: hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), typhoid fever, E. coli, or streptococcus
- drugs: penicillin, antimalaria medications, sulfa medications, or acetaminophen
- autoimmune disorders such as systemic lupus erythematous (SLE, or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
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The following are the most common symptoms of hemolytic anemia. However, each child may experience symptoms differently. Symptoms may include:
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- pale skin, lips, hands, or pale under the eyelids
- jaundice, or yellowing of the skin and eyes
- dark color to urine
- fever
- weakness
- dizziness
- confusion
- intolerance to physical activity
- enlargement of the spleen and liver
- increased heart rate (tachycardia)
- heart murmur
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The symptoms of hemolytic anemia may resemble other blood conditions or medical problems. Always consult your child's physician for a diagnosis.
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Hemolytic anemia may be suspected from general findings on a complete medical history and physical examination of your child, such as complaints of tiring easily, pale skin and lips, or a fast heartbeat (tachycardia). In addition to a complete physical examination, your child's physician may order the following diagnostic tests:
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- blood tests (to measure hemoglobin and reticulocyte count; test that reveals how many new red blood cells are being produced)
- additional blood tests (to check liver function as well as the presence of certain antibodies)
- urine tests
- bone marrow aspiration and biopsy - marrow may be removed by aspiration or a needle biopsy under local anesthesia. In aspiration biopsy, a fluid specimen is removed from the bone marrow. In a needle biopsy, marrow cells (not fluid) are removed. These methods are often used together.
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Specific treatment for hemolytic anemia will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- extent of the anemia
- cause of the anemia
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the anemia
- your opinion or preference
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The treatment for hemolytic anemia will vary depending on the cause of the illness. Treatment may include:
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- blood transfusions
- corticosteroid medications
- treatment with intravenous immune globulin (to strengthen the immune system)
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In more severe cases, the following treatments may be necessary and usually require hospitalization:
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- exchange transfusion (similar to a blood transfusion but with more blood being given and an equal amount of the child's hemolyzed blood being removed)
- surgical removal of the spleen (usually reserved for children who do not respond to other therapies)
- immunosuppressive therapy
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