HEMOLYTIC ANEMIA

Hemolytic anemia is a blood disorder that makes your red blood cells break down or die faster than your
body can replace them with new blood cells. People may develop hemolytic anemia due to genetic
conditions that cause anemia certain infections and certain medications. Sometimes, people have mild
hemolytic anemia symptoms that go away after treatment. Many times, healthcare providers can cure
hemolytic anemia after finding out what caused the condition. Left untreated, however, severe
hemolytic anemia can cause serious heart trouble.

There are 2 main types of hemolytic anemia: inherited and acquired. Different diseases, conditions, or
factors can cause each type:

1. Inherited

With the inherited type, parents pass the genes for the condition on to their children. Two common
causes of this type of anemia are sickle cell anemia and thalassemia. These conditions produce red blood
cells that don’t live as long as normal red blood cells.

2. Acquired

With this type of anemia, you are not born with a certain condition. Your body makes normal red blood
cells, but they are later destroyed. This may happen because of:

Certain infections, which may be viral or bacterial

 Medicines, such as penicillin, antimalarial medicines, sulfa medicines, or acetaminophen

 Blood cancers
 Autoimmune disorders, such as lupus, rheumatoid arthritis, or ulcerative colitis
 Certain tumors
 An overactive spleen (hypersplenism)
 Mechanical heart valves that may damage red blood cells as they leave the heart
 A severe reaction to a blood transfusion

Some types of acquired hemolytic anemia are short-term (temporary) and go away over several months.
Other types can become lifelong (chronic). They may go away and come back again over time.

CAUSES

Hemolytic anemia may be caused by inherited conditions that affect the red blood cells. It’s also caused
by certain infections or if someone receives a blood transfusion from a donor whose blood type didn’t
match and or medication effects.

inherited conditions causes:

 Sickle cell anemia: In this disease, your body produces abnormally shaped red blood cells that
are trapped in small blood vessels, your spleen or liver.
 Thalassemia: This is another group of inherited blood disorders that cause your body to make
abnormal red blood cells that are easily destroyed.
  G6PD deficiency: This genetic disorder affects an enzyme that protects red blood cells. When
this enzyme level drops, blood cells exposed to certain infections or medications are likely to
break apart.

Infections linked to hemolytic anemia include:

 Malaria: This disease happens when mosquitos infected with tiny malaria parasites bite people,
leaving parasites in people's bloodstreams. Left untreated, malaria can cause hemolytic anemia.
 Rocky Mountain spotted fever: This infection spreads when ticks infected with the bacteria
Rickettsia rickettsi bite people.
 Haemophilus influenza disease: These are infections caused by the bacteria H. influenza.
 Human immunodeficiency virus (HIV): This virus causes acquired immune deficiency syndrome
(AIDS).

Medication causes include:

 Penicillin: These antibiotic treats infections and other serious medical problems.
 Quinine: This medication treats malaria.
 Methyldopa: This medication treats high blood pressure.
 Sulfonamides: This is an anti-bacterial medication.

SIGNS AND SYMPTOMS:

Hemolytic symptoms can be mild or more severe. They also can come on suddenly or develop over time.
Typical symptoms include:

 Jaundice: This condition affects your skin, the whites of your eyes (sclera) and your mucous
membranes, causing them to turn yellow. This happens when you have a high level of bilirubin
caused by a breakdown of your red blood cells.
 Shortness of breath (dyspnea): This happens when you don’t have enough red blood cells
carrying oxygen throughout your body.
 Fatigue: Fatigue is a sensation of being so tired that it affects your daily life and your ability to do
your daily activities.
 Fast heartbeat (tachycardia): This condition means your heart is beating faster than it should.
When your heart beats too fast, it doesn’t have enough time between beats to fill up with blood,
and your heart can’t supply your body with the oxygen it needs.
 Low blood pressure (hypotension): Low blood pressure can be a symptom or a condition. It
happens when your blood pressure is much lower than expected.
 Blood in your pee (hematuria): This can be a symptom of sickle cell disease.
 Enlarged spleen or liver: Your liver and spleen filter red blood cells as the cells move through
your body. Red blood cells that are damaged or dying are trapped by your spleen and liver, which
destroy the cells. A larger-than-normal spleen or liver may be a sign your red blood cells are
damaged.
RISK FACTORS:

Certain conditions can cause hemolysis to happen too fast or too often, including the following:

 autoimmune conditions
 Bone marrow failure
 Complications from blood transfusions
 Infections
 inherited blood conditions such as sickle cell disease or thalassemia
 Some medicines

PATHOPHYSIOLOGY

DIAGNOSTIC PROCEDURE:

Your healthcare provider may think you have hemolytic anemia based on your symptoms, your medical
history, and a physical exam. Your provider may also order the following tests:

 Complete blood count (CBC). This test measures many different parts of your blood.
 Urine test. This can check for hemoglobin (a protein in red blood cells) and iron.
 Bone marrow aspiration or biopsy. This involves taking a small sample of bone marrow fluid
(aspiration) or solid bone marrow tissue (called a core biopsy). The sample is usually taken from
the hip bones. It is checked for the number, size, and maturity of blood cells or abnormal cells.
  Other blood tests. If the CBC test shows that you have anemia, you may have other blood tests.
These can find out what type of anemia you have and how serious it is. This test includes the
following that is used to detect anemia.

 Coombs test (direct antiglobulin test):This test checks for autoimmune hemolytic anemia.

 Reticulocyte count: A reticulocyte count measures the number of immature red blood cells
(reticulocytes) in your bone marrow. Healthcare providers measure reticulocytes to find out if
your bone marrow is producing enough healthy red blood cells.

 Haptoglobin test: Haptoglobin is a protein that eliminates debris produced by damaged red
blood cells. Low haptoglobin levels may be a sign of damaged red blood cells.

 Lactate dehydrogenase (LDH): LDH is an enzyme in red blood cells. A high LDH level may be a
sign of increased red blood cell destruction.

 Unconjugated bilirubin: When your red blood cells break down, they make bilirubin. This test
measures the amount of bilirubin that’s not being processed by your liver. This is unconjugated
bilirubin. A high unconjugated bilirubin level may be a sign that large numbers of red blood cells
are being destroyed.

 Peripheral blood smear: Healthcare providers examine blood cells for signs of abnormalities,
including size and shape.

 Hemoglobin electrophoresis: Healthcare providers use this test to analyze hemoglobin, a

protein in your red blood cells that helps cells carry oxygen throughout your body.

TREATMENT

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

 Blood transfusions
 Corticosteroid medicines
 Treatment to strengthen your immune system (using intravenous immune globulin)
 Rituximab

In more severe cases, the following treatments may be needed:

 Surgery to remove the spleen

 Medicine to reduce the strength of your immune system (immunosuppressive therapy)
NURSING INTERVENTIONS

INDEPENDENT

 Rest as much as possible. Hemolytic anemia can cause you to feel more tired than usual.
 Eat a variety of healthy foods. This may help you have more energy and heal faster. Healthy
foods include fruit, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat,
and fish. Ask your healthcare provider if you need to be on a special diet.
 Drink liquids as directed. Ask your healthcare provider how much liquid to drink and which
liquids are best for you. For most people, good liquids are water, juice, and milk.
 Exercise as directed. Talk to your healthcare provider about the best exercise plan for you.
Exercise can decrease your blood pressure and improve your health. Assist the patient in
prioritizing activities and establishing balance between activity and rest that would be
acceptable to the patient.
 Blood transfusion monitoring. The nurse should monitor the patient’s vital signs and pulse
oximeter readings closely.
 Enhance compliance. The nurse should assist the patient to develop ways to incorporate the
therapeutic plan into everyday activities.

COLLABORATIVE

 Medication intake. Assist the patient in taking prescribed medicines by his/ her physician. Let
your know the side effects to relieve anxiety upon taking his/ her medications.
 Nutritional supplements. Use of nutritional supplements should be appropriately taught to the
patient and the family because too much intake cannot improve anemia.
 Blood transfusion. Patients with acute blood loss or severe hemolysis may have decreased tissue
perfusion from decreased blood volume or reduced circulating erythrocytes, so transfusion of
blood would be necessary by physicians order.
 Intravenous fluids. Intravenous fluids replace the lost volumes of blood or electrolytes to restore
them to normal levels.
REFERENCE

Alder Laura, Tambe AJ. Acute Anemia

(https://www.ncbi.nlm.nih.gov/books/NBK537232/#_NBK537232_pubdet_). StatPearls. Accessed
3/3/2022.

American Family Physician.Hemolytic Anemia: Evaluation and Differential Diagnosis.

(https://www.aafp.org/afp/2018/0915/p354.html) Accessed 3/3/2022.

Baldwin Caitlyn, Pandey Jyotsna, Olarewaju Olubunmi. Hemolytic Anemia. StatPearls

(https://www.ncbi.nlm.nih.gov/books/NBK558904/#_NBK558904_pubdet_). Accessed 3/3/2022.

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