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Hemolytic Anemia

What is hemolytic anemia?

Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than they can be made. The term for destruction of red blood cells is hemolysis. There are two types of hemolytic anemia, intrinsic and extrinsic.

What causes hemolytic anemia?

Possible causes of hemolytic anemia include:


The destruction of the red blood cells is due to a defect within the red blood cells themselves. Intrinsic hemolytic anemias are often inherited. Examples include sickle cell anemia and thalassemia. These conditions produce red blood cells that do not live as long as normal red blood cells.


Normal red blood cells are made but are later destroyed by becoming trapped in the spleen, destroyed by infection, or destroyed from drugs that can affect red blood cells. In severe cases, the destruction takes place in the circulation. Possible causes of extrinsic hemolytic anemia include:
  • Infections, such as hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), typhoid fever, E. coli, mycoplasma pneumonia, or streptococcus
  • Medications, such as penicillin, antimalarial medications, sulfa medications, or acetaminophen
  • Leukemia or lymphoma
  • Autoimmune disorders, such as lupus, rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
  • Various tumors
  • An over active spleen (hypersplenism)
  • Mechanical heart valves that may shear red blood cells as they leave the heart
  • Autoimmune hemolytic anemia, in which the body's immune system creates an antibody against its own blood cells

Some types of extrinsic hemolytic anemia are temporary and resolve over several months. Other types can become chronic with periods of remissions and recurrence.

What are the symptoms of hemolytic anemia?

The following are the most common symptoms of hemolytic anemia. However, each person may experience symptoms differently. Symptoms may include:

  • Abnormal paleness or lack of color of the skin
  • Jaundice, or yellowing of the skin, eyes, and mouth
  • Dark-colored urine
  • Fever
  • Weakness
  • Dizziness
  • Confusion
  • Intolerance to physical activity
  • Enlargement of the spleen and liver
  • Increased heart rate (tachycardia)
  • Heart murmur

The symptoms of hemolytic anemia may look like other blood conditions or medical problems. Always consult your health care provider for a diagnosis.

How is hemolytic anemia diagnosed?

Your doctor may suspect hemolytic anemia based on your symptoms and a complete medical history and physical exam. In addition, your health care provider may order the following tests:

  • Blood tests. These tests measure hemoglobin and reticulocyte count and will reveal how many new red blood cells are being made.
  • Additional blood tests. These tests check liver function as well as the presence of certain antibodies.
  • Urine tests for hemoglobin
  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

How is hemolytic anemia treated?

Specific treatment for hemolytic anemia will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Cause of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

The treatment for hemolytic anemia will vary depending on the cause of the illness. Treatment may include:

  • Blood transfusions
  • Corticosteroid medications
  • Treatment with intravenous immune globulin (to strengthen the immune system)
  • Rituximab

In more severe cases, the following treatments may be needed and usually require hospitalization:

  • Exchange transfusion (similar to a blood transfusion but with more blood being given and an equal amount of hemolyzed blood being removed)
  • Surgical removal of the spleen
  • Immunosuppressive therapy

Living with hemolytic anemia

It important to work with your health care provider to minimize your risk for episodes of hemolysis, and to reduce your chances of infections. For instance, many people with hemolytic anemia are susceptible to cold, which can trigger the breakdown of red blood cells. By avoiding the cold, wearing warm clothes, and keeping your home warmer, you may minimize your risks. You can reduce your risk for infections by staying away from those who are sick, avoiding large crowds, washing your hands often, avoiding undercooked foods, brushing your teeth regularly, and getting your annual flu shot.

Key points about hemolytic anemia

  • Hemolytic anemia is a disorder in which the red blood cells are destroyed faster than they are made.
  • Causes of hemolytic anemia can be intrinsic, such as sickle cell anemia and thalassemia
  • Causes can also be extrinsic, such as infections, medications, leukemia, autoimmune disorders, or tumors
  • Symptoms include weakness, paleness, jaundice, dark-colored urine, fever, intolerance to exercise, and heart murmur
  • Treatment includes blood transfusions, corticosteroid medications, and other medications
  • It is important to avoid triggers of hemolysis and sources of infection

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Hemolytic Anemia - WellSpan Health

Online Medical Reviewer: Fetterman, Anne, RN, BSN
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Last Review Date: 2014-02-06T00:00:00
Last Modified Date: 2016-07-28T00:00:00
Published Date: 2016-07-28T00:00:00
Last Review Date: 2007-03-30T00:00:00
© 2016 WellSpan Health. All Rights Reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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