Hemolytic Anemia

What is Hemolytic Anemia?

This type of anemia is due to a premature destruction of the red cells. Generally speaking it is fairly uncommon, and as care in the use of drugs looking out for situations in which it is likely to occur (such as Rh incompatibilities), and taking the necessary precautions increases, the risks are now far less than they were a few years ago. Apart from some of the usual symptoms of anemia (sometimes a feature. sometimes not, depending on the degree of anemia present), other typical symptoms are associated with it.

Hemolytic Anemia Symptoms

Jaundice (yellowing of the skin and whites of the eyes) can occur. This is due to the excessive breakdown of the red cells, and the production in large amounts of a chemical called bilirubin. The urine and feces may become severely pigmented also, as large amounts of bilirubin are excreted through these systems.

The blood picture (when examined under the microscope) shows typical changes. The bone marrow makes increasing efforts at stepping up red cell production to cope with the rapid rate of cell destruction. For this reason, red cells that have not matured properly are pumped into the general circulation.

These immature cells appear in profusion. The level of actual anemia depends on the body’s ability at balancing the rate of cell destruction with the rate of new cells being made available. In this way, the symptoms of typical red cell anemia will vary from case to case.

Also, abnormal by-products of red cell destruction are usually found in the urine. There is an extensive battery of tests available to help doctors decide which type of anemia is present, and to help pinpoint the probable cause. Most of the others are rarely seen by doctors in the ordinary routine of practice, and the majority is only diagnosed upon investigation in a large hospital equipped to deal with the full range of investigations.

From the practical point of view, it is essential that any of the telltale symptoms mentioned receive prompt medical attention. Your doctor will very quickly have you referred to the appropriate centers for total assessment and treatment. Treatment of these disorders has no place in home medicine, and trying simple home remedies and following the advice of well-meaning relatives and friends is a total waste of time and could be harmful in precluding vital medical attention.

Jaundice, an important symptom in this type of anemia, warrants immediate medical advice from a doctor.

Some of the more probable types of hemolytic anemia include:

Hemolytic Disease of the Newborn

The most likely situation in which this may occur is when an Rh-negative mother produces an Rh-positive infant, and the cells from the baby stimulate the mother to form anti-Rh (usually anti-D) antibodies.

These antibodies can then cross via the placenta and become attached to the baby’s red cells, causing their destruction (hemolysis).

Generally there is a history of a previous pregnancy or miscarriage in the mother, and during the birth of the first baby (who usually comes through unscathed) the release of fetal cells into the mother’s circulation takes place, and sets up the antibody production that will affect later babies.

Each subsequent baby will tend to be affected more severely It may be lethal to the baby, and a condition called hydrops foctolis can develop unless immediate steps are taken soon after birth. Formerly the only method of treatment was to give a prompt exchange transfusion to the baby. In this way, the diseased blood was removed, new blood replacing it completely.

It was a time-consuming and arduous undertaking and a marathon event for a newborn infant. However many lives were saved in this manner. In the late 1960s it was found that if the mother were given a special single injection of anti-D antibody within 7 2 hours of the birth of her Rh-positive infant, this effectively stopped production of the antibodies, and the risk to subsequent babies was greatly reduced.

As a new generation of mothers is growing up, and with routine blood tests being carried out before and at the time of birth (on the mother and infant), treatment is now effectively cutting back on this form of anemia. In time it will most likely disappear altogether.

However, a miscarriage, abortion or blood transfusion (with Rh-positive blood in an Rh-negative woman) may lead to similar complications later on in pregnancy.

Incompatible Blood Transfusion

The most obvious example of hemolytic anemia occurs when a patient is given the wrong blood during a transfusion. This is termed “incompatible” blood. In 1900 Karl Landsteiner showed that there were four main blood groups that could destroy incompatible red cells. For example, if a patient of group B is given group A blood, the group A cells will be destroyed by the anti-A in the recipient’s plasma. That is why great care is taken to type and cross-match blood before every blood transfusion. Only group 0 blood may be given in a dire emergency without cross-matching with relative safety, for it contains no antigens.

Symptoms that may occur when the wrong blood is given include acute hemolysis, the appearance of hemoglobin in the urine, fever and severe back pain, and frequently renal disorders. Most of the mistakes that occur causing this reaction have been found due to administrative errors at the hospital (wrong labels on bottles, failure to check labels correctly etc).

Hemolytic Anemia Due to Drugs and Chemicals

Certain drugs are well-known for their ability at reacting on the red cells and causing their premature destruction. This may occur almost at once, or in others it may occur about 10 days after administration of the drug, the first dose apparently sensitizing the system and later doses having an immune type reaction. But the result is the same, irrespective of the cause—red cells disintegrating and possibly causing a medical emergency.

Other Causes

A variety of other causes have been incriminated. Certain bacterial infections appear capable of producing bone-marrow depression and red-cell destruction.

Mechanical trauma of the red cells can cause their premature breakdown in others. Apparently healthy young men doing a lot of marching or running particularly on hard surfaces for prolonged periods of time, may damage the red cells in the blood circulating in their feet.

Hemoglobin is later passed in the urine a frightening experience. It is harmless and wearing rubber insoles in the boots should correct the problem.

Burns may have a similar effect, the red cells becoming directly damaged or else suffering damage as they flow through injured vessels. They subsequently tend to fragment and hemolyse. In these modern times, when Teflon is being used in cardiac surgery unless the prosthesis is completely covered with normal cells, red cell damage can occur similarly leading to cell destruction.

Other prosthetics can cause similar cell damage, a problem of modern surgery limited to the second half of the 20th century. It will probably increase as does the rate of surgery of this nature.

Enlarged Spleen

The spleen is an integral part of the reticulo-endothelial system of the body apparatus that deals with red cells once their useful life has come to an end. They are disposed of quietly, and their place taken over by the ever-proliferating number of new red cells produced in bone marrow.

However, if there is splenic enlargement from any reason, the organ may overreact and increase in its rate of destroying the red cells.

Many disorders can lead to splenic enlargement, even simple viral infections such as a glandular fever or viral hepatitis or any other mild viral infection. But some of the infections and conditions producing an enlarged spleen are rarer and more bizarre.

If it can be shown that normal red-cell production is taking place in the marrow and that destruction in the spleen is excessive, its removal could be the choice of treatment.