What Is Hemolytic Anemia?

Anemia is when the number of red blood cells in the body gets too low. Red blood cells contain hemoglobin, a protein that carries oxygen throughout the body. Without enough red blood cells, oxygen doesn't get to the body's organs. Without enough oxygen, the organs can't work normally.

Hemolytic (hee-muh-LIT-ik) anemia is a type of anemia that happens when red blood cells break down faster than the body can make them.

Depending on the type of hemolytic anemia, symptoms can be mild or very severe. There are treatments that can help.

What Are the Signs & Symptoms of Hemolytic Anemia?

Symptoms of hemolytic anemia may be mild and slowly get worse, or become severe quickly. Someone with hemolytic anemia might:

• look pale
• seem moody
• be very tired
• feel dizzy or lightheaded
• have a fast heartbeat
• breathe fast or feel short of breath
• have jaundice (yellow skin and eyes)
• have an enlarged spleen
• have dark, tea-colored pee

What Causes Hemolytic Anemia?

There are many different causes for hemolytic anemia. Some causes are inherited (passed from parents to children) and some are not.

Inherited hemolytic anemias include:

• sickle cell anemia
• G6PD (glucose-6-phosphate dehydrogenase) deficiency
• PK (pyruvate kinase) deficiency
• hereditary spherocytosis
• hereditary elliptocytosis (ovalocytosis)
• thalassemias

Hemolytic anemias that are not inherited include:

• autoimmune hemolytic anemia: This happens when the infection-fighting immune system attacks red blood cells. Some medicines or an infection can trigger this as well some autoimmune diseases like lupus.
• mechanical hemolytic anemia: This happens when something destroys red blood cells, such as:
  • a heart/lung bypass machine (ECMO)
  • an artificial heart valve
  • walking or running for a long time (called "march hemoglobinuria")
  • abnormal blood vessels (microangiopathic hemolytic anemia)
  • cancer
  • chemicals such as lead, arsenic, and snake venom

How Is Hemolytic Anemia Diagnosed?

Doctors usually can diagnose hemolytic anemia by:

• asking about symptoms
• asking if any family members have anemia
• doing an exam
• doing blood tests to:
  • look at the red blood cells with a microscope
  • test for antibodies to see if the immune system is attacking them (called a Coombs test)
  • check how fast the body is making new red blood cells
  • look for signs that many red blood cells are breaking down
  • check for any inherited anemias using specialized testing, sometimes genetic testing

How Is Hemolytic Anemia Treated?

Treatment for hemolytic anemia depends on the cause. A hematologist (a doctor who treats blood problems) helps children with hemolytic anemia get the treatment they need. These treatments may include:

• blood transfusions (giving the child donated red blood cells)
• medicines (often steroids) to weaken the immune system's attack on red blood cells
• antibodies given through a vein (intravenous immunoglobulin, IVIG)
• removal of the spleen (splenectomy)
  
• treatment with folic acid

How Can Parents Help?

Sometimes hemolytic anemia goes away with treatment and never comes back. But in some children, it causes ongoing medical problems. Many of these are treatable. The hematologist can help parents understand the details of their child's hemolytic anemia and recommend the best treatment.

To help your child get the best care:

• Go to all doctor's visits.
• Follow the doctor's recommendations.