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Hemolytic Anemia

  • Hemolytic Anemia

    Hemolytic anemia is a blood disorder that occurs when red blood cells are destroyed faster than the bone marrow can make them. There are two types of hemolytic anemia: intrinsic, which is inherited, and extrinsic which can be caused by certain infections, medications or autoimmune disorders.


    Hematolytic Anemia Treatment at Dana-Farber/Boston Children's

    Patients with Hematolytic Anemia are treated through the Blood Disorders Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children's Hospital.

  • What is hemolytic anemia? 

    Hemolytic anemia is a blood disorder that occurs when red blood cells, the part of the blood that helps carry oxygen from the lungs to all the parts of the body, are destroyed faster than the bone marrow can make them. The destruction of red blood cells is called hemolysis.

    Types of hemolytic anemia:

    Intrinsic (present at birth):

    • Red blood cells are destroyed due to a defect within the red blood cells themselves.
    • Results in red blood cells that do not live as long as normal red blood cells.

    Extrinsic:

    • Red blood cells are healthy when produced but are later destroyed by getting trapped in the spleen. Or they may be destroyed by infection or certain medications.

    What causes hemolytic anemia?

    Intrinsic hemolytic anemias, such as thalassemia or sickle cell anemia, are inherited, passed from parents to their child through a defective gene. Extrinsic hemolytic anemia can be caused by:

    Infections:

    • Hepatitis
    • Cytomegalovirus
    • Epstein-Barr virus
    • Typhoid fever (bacterial infection most commonly caused by salmonella)
    • E. coli (bacteria that cause food poisoning)
    • Streptococcus

    Medications:

    • Penicillin
    • Antimalaria medications
    • Sulfa medications
    • Acetaminophen

     Autoimmune disorders:

    Leukemia or lymphoma

    Various tumors 

    What are the symptoms of hemolytic anemia?

    The most common symptoms of hemolytic anemia are:

    • pale skin, lips, hands, or paleness under the eyelids
    • jaundice
    • dark color to urine
    • fever
    • weakness
    • dizziness
    • confusion
    • difficulty with physical activity
    • enlargement of the spleen and liver
    • increased heart rate
    • heart murmur
  • How does a doctor know that it’s hemolytic anemia?

    Hemolytic anemia may be suspected based general findings from a complete medical history and physical examination, including:

    • complaints of tiring easily
    • pale skin and lips
    • fast heartbeat

    Blood tests, urine tests and a full bone marrow exam in which samples of the fluid (aspiration) and solid (biopsy) portions of bone marrow are withdrawn with a needle under local anesthesia may also be performed to confirm diagnosis.

  • Treatment of hemolytic anemia varies depending on its cause and may include: 

    Steroid therapy:

    • Increases hemoglobin or red blood cells
    • Taken orally in liquid or pill form every day or every other day in divided doses
    • sSde effects may include: upset stomach, increased appetite, weight gain, unstable blood sugars, increased blood pressure, decreased height and increased risk for infection
    • Dose is often low enough that few or no side effects occur

    Red blood cell transfusions:

    • Used when anemia is unusually severe or when steroid therapy is not effective
    • Red blood cells are delivered through a needle or catheter inserted into a vein.
    • Given at hospital or outpatient transfusion center
    • Transfusions typically take two to four hours and may be repeated every four to eight weeks.
    • Side effects may include: fever, headache, hives, allergic reaction, infection and iron overload

    Intravenous immune globulin:

    • Human blood product that strengthens the immune system
    • Given through a needled inserted into a vein
    • Temporary side effects include: mild anemia, fever, chills, headache, blood pressure changes or allergic reactions

    If your child has severe hemolytic anemia, the following treatments, usually given while in the hospital, may be needed: 

    • Exchange transfusion to replace damaged blood with fresh blood
    • Surgery to remove the spleen (usually reserved for children who do not respond to other therapies)
    • Immunosuppressive therapy (therapy to suppress the immune system)

  • Clinical Trials

     For many children with rare or hard-to-treat conditions, clinical trials provide new options. 

    Research

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