Hemolysis

Hemolysis is an uncommon cause of jaundice. The rate of RBC destruction determines the degree to which jaundice is seen. In most cases, hemolysis occurs in patients with known hemoglobinopathies or RBC diseases (such as sickle cell disease [SCD]) and a concurrent oxidative stress such as hypoxia, infection, acidosis, or oxidative drug usage. Mechanical and infectious hemolysis include microangiopathic hemolytic anemia (MAHA), repetitive trauma to feet or hands, heart valve irregularities, hypersplenism, burns, malaria, and Mycoplasma and parvovirus infection. Uremia and hypophosphatemia are metabolic causes. Hemolysis is idiopathic in approximately 50% of cases in which an autoimmune reaction apparently is responsible for RBC destruction.

Causes

Causes of hemolytic anemia include infection, certain medications, autoimmune disorders, and inherited disorders.

Medications may cause the body to develop antibodies that bind to the red blood cells and cause their destruction in the spleen. Immune hemolytic anemia most commonly involves antibodies that react against the red blood cells at body temperature, which can cause premature destruction of the cells. Cold-antibody hemolytic anemia is a condition in which the antibodies react with the red blood cells at a temperature below that of normal body temperature. Red blood cells can also receive mechanical damage as they circulate through the blood vessels. Aneurysms, artificial heart valves, or very high blood pressure can cause the red cells to break up and release their contents. In addition, hemolytic anemia may be caused by a condition called hypersplenism, in which a large, overactive spleen rapidly destroys red blood cells.

Symptoms

• Progressive fatigue, weakness, lightheadedness
• Syncope, near-syncope if concomitant vascular disease
• Dyspnea on exertion
• Palpitations
• Abdominal pain, back pain, and black urine can occur in severe intravascular hemolysis.
• Bleeding if associated DIC
• Hemoglobinuria on voiding after sleep (paroxysmal nocturnal hemoglobinuria)

Signs

• An acute drop in hemoglobin from any cause of hemolysis can produce shock, tachypnea, tachycardia, mental status changes, and CHF.
• Pallor
• Jaundice
• Splenomegaly occurs in most forms of immune-mediated hemolysis (not in SCD); children with SCD may exhibit splenomegaly and shock.

Treatment

This treatment may such as includes Nutritional supplements - Iron, B12, Treatment of infections, inflammations, Erythropoietin. Blood transfusions Providing red blood cell transfusions for bleeding and severe chronic anemias may be lifesaving. Red cell transfusions are the old mainstay, which offers the quickest relief for anemias. But, there are risks associated with transfusions.