Hemolytic anemia occurs due to abnormal breakdown of red blood cells, inside the blood vessels (intravascular hemolysis) or outside the blood vessels (extra vascular hemolysis). Usually there are two types of hemolytic anemia, inherited (genetic) and acquired. The treatment of hemolytic anemia is based on the cause of hemolysis and correction (if possible) of the cause.

What are the symptoms of hemolytic anemia?

The symptoms of hemolytic anemia are same as that of the symptoms of iron deficiency anemia with additional symptom of jaundice (yellow discoloration of skin and mucous membranes). Jaundice in hemolytic anemia occurs due to breakdown of red blood cells. When red cells are broken down, it liberates hemoglobin, which is further broken down to form bilirubin, which is responsible for yellowness of skin and mucous membranes and manifest as jaundice. Jaundice can cause long term complications such as formation of gall bladder stones (gall stones) and pulmonary hypertension.

Important features of hemolytic anemia:

• Abnormal and increased destruction of red blood cells and their precursors in some cases.
• Increased breakdown of hemoglobin which is released from broken red blood cells, which cause increase production of bilirubin and jaundice results. Fecal and urinary urobilinogen also increase. Hemoglobinanemia, methaemalbuminaemia, hemoglobinuria and hemosiderinuria occurs if there is increased intravascular hemolysis.
• Bone marrow tries to compensate increase breakdown of red cells and increase production of red cells and there is increase number of red cell precursors such as reticulocytes.
• The balance between compensatory mechanism of bone marrow and red cell destruction decides the severity of hemolytic anemia.

Treatment of hemolytic anemia:

Definitive treatment of hemolytic anemia is based on the cause of the disease. Symptomatic treatment includes blood transfusion (if there is significant anemia). If hemolytic anemia is due to some immune related problem, steroid therapy may be indicated. In some selected cases such as extra vascular hemolysis (or in cases where extra vascular hemolysis is predominant), improve if splenectomy (surgical removal of spleen) is done, as most red cells are removed by spleen.

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