What Is Hemolytic Anemia?

Hemolytic anemia is a condition in which the destruction of red blood cells ( erythrocytes ) is faster than its formation. The occurence of hemolytic anemia can be triggered by factors from within the red blood cells ( intrinsic ) as well as factors from outside red blood cells ( extrinsic ).

Extrinsic haemolytic anemia is a haemolytic anemia caused by an immune system response that stimulates the spleen to destroy red blood cells. While intrinsic hemolytic anemia is a hemolytic anemia caused by abnormal red blood cells. The condition causes red blood cells do not have a lifetime like normal cells. Intrinsic hemolytic anemia is generally genetically inherited, such as sickle cell anemia or thalassemia .

Both extrinsic and intrinsic hemolytic anemia may appear in the short-term (temporary) as well as appear as chronic disease. Temporary hemolytic anemia can be treated and lost after several months, whereas chronic haemolytic anemia can be suffered for life and cause recurrence after a certain period of time.

Hemolytic anemia can occur in anyone regardless of age, and can be caused by various things. In some patients, hemolytic anemia presents only mild symptoms. While on the other hand, this condition requires intensive care throughout life.


Causes of Hemolytic Anemia
Some conditions that can lead to the occurrence of intrinsic hemolytic anemia are:

• Sickle cell anemia.
• Talassemia.
• Deficiency of glucose-6-phosphate dehydrogenase (G6PD) enzyme.
• The enzyme deficiency of pyruvate kinase

While some conditions that may lead to the occurrence of extrinsic hemolytic anemia are:

• Enlarged spleen.
• Epstein-Barr and Hepatitis virus infections.
• Coli bacterial infections , Salmonella typhi, and Streptococcus sp.
• Leukemia.
• Lymphoma .
• Tumor.
• Lupus .
• Wiskott-Aldrich Syndrome.
• HELLP syndrome.

Extrinsic haemolytic anemia may also occur due to side effects of certain drugs, such as:

• Paracetamol.
• Antibiotics, especially penicillin, ampicillin, and meticillin.
• Chlorpromazine .
• Ibuprofen.
• Interferon
• Procainamide .
• Quinine (quinine).
• Rifampin .

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One of the major causes of severe hemolytic anemia is a blood transfusion error in which the donor and recipient blood groups are unsuitable. If the donor recipient is given a blood that does not fit the group, then the antibodies contained in the blood plasma of the person will attack red blood cells in donated blood. This condition can cause extensive damage to red blood cells in the body.
There is also a so-called microangiopathic hemolytic anemia, a condition in which red blood cells are fragmented. Some diseases that can cause these conditions are:

• Artificial heart valve disturbance.
• Hemolytic haemolytic syndrome (SHU).
• Thrombo tic thrombocytopenic purpura (TTP).
• Disseminated Intravascular Coagulation (DIC).

While in newborns, there is a condition of hemolytic anemia called fetal eritroblastosis. This condition occurs due to incompatibility of rhesus blood group between pregnant women with the fetus. If a pregnant woman has a rhesus negative blood group and a rhesus positive fetal fetus, there is a possibility that the fetus in the womb has a positive rhesus. This will cause the fetal red blood cells to be attacked by antibodies from the mother's body. Fetal eritroblastosis cases commonly occur in the second pregnancy when the pregnant mother already has antibodies formed from the first pregnancy.

Hemolytic anemia disease is quite dangerous for infants due to complications of the anemia. Currently, treatment for infants with fetal erythroblastosis is by intravenous immunoglobulin (IVIG) or blood transfusion. Doctors can also prevent the appearance of fetal erythroblastosis in pregnant women diagnosed with the condition by giving the injection of RhoGAM at 28 weeks gestation.


Symptoms of Hemolytic Anemia
The symptoms of hemolytic anemia are similar to those of other types of anemia. To distinguish it, further diagnosis is necessary. Some of the common symptoms of haemolytic anemia are:

• Pale skin.
• Fatigue.
• Fever.
• Head feels heavy and dizzy.
• Dizzy.
• Tired and unable to perform heavy physical activity.

While other symptoms that may also appear in patients with hemolytic anemia are:

• Urine that turns dark.
• The skin and whites of the eyes are yellow.
• The heart felt rustling.
• Heart rate increases.
• Enlargement of the spleen and liver.

Diagnosis of Hemolytic Anemia
The doctor will inquire about the symptoms that appear, review the patient's medical history, and perform a physical examination as a first step in the diagnosis of haemolytic anemia.
At the time of physical examination, the doctor will also check the color of the skin (especially if there is yellowing on the skin or on the white eye). After that the doctor will check the patient's stomach to see any hardening or swelling as a sign of the enlargement of the liver and spleen.

If the patient is suspected of hemolytic anemia, the doctor will perform blood checks. Some of the parameters checked are as follows:

• Total blood count, in order to know the number of blood cells in the patient.
• Bilirubin, to determine the number of red blood cells that are destroyed by the liver. In patients with hemolytic anemia, the concentration of unconjugated bilirubin in the body is generally below 0.3 mg / L.
• Hemoglobin, to determine the amount of red blood cells that are still alive.
• The number of reticulocytes, to determine the number of red blood cells produced by the body.
• Liver function.

Some additional tests that may help diagnose hemolytic anemia are:

• Urine test, to detect the presence of blood cells in the urine.
• Bone marrow biopsy, to determine the number of red blood cells produced and its shape.
• Blood staining ( peripheral blood smear). Blood staining is used to look at blood cell shape through microscopic observation. Through this examination, the doctor can know the maturity of blood cells, blood cell fragmentation, and so on. Blood staining can also detect whether a person has sickle cell anemia or is not seen from his red blood cell form.
• Study of the enzyme lactate dehydrogenase. The enzyme lactate dehydrogenase is one of the important indicators in determining the presence of hemolysis in patients. Patients with hemolytic anemia may be diagnosed from elevated serum lactate dehydrogenase in the blood. However, some other malignant (cancer) diseases may also increase serum levels of lactate dehydrogenase in the blood.
• Study serum haptoglobin. A decrease in serum haptoglobin in the blood may indicate a moderate to severe hemolytic anemia.

Treatment of Hemolytic Anemia
Treatment of hemolytic anemia will depend on the severity of anemia, age, general patient health condition, and patient tolerance to certain drugs. Methods of hemolytic anemia treatment include:

• Blood transfusion. Blood transfusion aims to increase the number of red blood cells of patients and replace damaged blood cells rapidly.
• Intravenous Immunoglobulin (IVIG). Lack of red blood cells can cause patients more susceptible to infection. To prevent this, the patient will be given immunoglobulins through intravenous fluids.
• Corticosteroids. In patients with extrinsic hemolytic anemia caused by autoimmune disease, corticosteroids serve to suppress the immune system's response so that the red blood cells are not destroyed easily.
• Surgical removal of the spleen. The spleen is an organ that destroys red blood cells. In cases of severe hemolytic anemia and can not be overcome with other treatment methods, the patient's spleen may be removed to reduce red blood cell damage.

For people with hemolytic anemia who have been diagnosed by a doctor, note the following things in order to undergo normal activities, including:

• Avoid direct contact with sick people, especially those affected by infectious diseases.
• Avoid crowds of people to lower the risk of infection.
• Routine hand washing.
• Avoid eating raw food.
• Routine tooth brushing.
• Daily flu vaccinations regularly.

Complications of Hemolytic Anemia
Some of the complications that can occur in people with hemolytic anemia are:

• The severity of anemia increases. In patients with intravascular hemolysis, iron deficiency due to chronic hemoglobinuria may aggravate anemias already present.
• Jaundice (jaundice).
• Heart failure.

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