Hemolytic Anemia
What is hemolytic anemia
Extrinsic hemolytic anemia is hemolytic anemia caused by an immune system response that stimulates the spleen to destroy red blood cells. Intrinsic hemolytic anemia, on the other hand, is hemolytic anemia caused by red blood cells that are not normal. This condition causes the red blood cells not having the same lifespan like normal cells. Intrinsic hemolytic anemia is typically derived genetically like sickle cell anemia or thalassemia.
Hemolytic anemia, either intrinsic or extrinsic, can appear in a short period of time (temporary) or as a chronic disease. Temporary hemolytic anemia can be treated and disappear after a few months, whereas chronic hemolytic anemia may suffer for a lifetime and cause recurrences after a certain time period.
Hemolytic anemia can happen to anyone regardless of age, and can be caused by various things. On some sufferers, hemolytic anemia only shows mild symptoms, while in others, this condition requires intensive care throughout life.
The Causes of Hemolytic Anemia
Some conditions that can lead to the onset of intrinsic hemolytic anemia are:
- Sickle cell anemia.
- Thalassemia.
- A deficiency of the glucose-6-phosphate dehydrogenase (G6PD) enzyme.
- A deficiency of the pyruvate kinase enzyme
- Some conditions that can lead to the onset of extrinsic hemolytic anemia are:
- Enlargement of the spleen.
- Epstein-Barr virus infection and Hepatitis.
- Coli bacteria, Salmonella typhi, and Streptococcus sp infections.
- Leukemia.
- Lymphoma.
- Tumor.
- Lupus.
- Wiskott-Aldrich Syndrome.
- HELLP Syndrome.
Extrinsic hemolytic anemia can also occur due to the side effects of certain drugs consumption, such as:
- Paracetamol.
- Antibiotics, especially penicillin, ampisilin, and metisilin.
- Chlorpromazine.
- Ibuprofen.
- Interferon
- Procainamide.
- Quinine (kina).
- Rifampin.
One of the main causes of severe hemolytic anemia is blood transfusion errors in which the donors and recipient’s blood type did not match. If the recipient is given blood donors that do not fit his blood type, the antibodies contained in the person's blood plasma will invade the red blood cells on the transfused blood. This condition can widely damage the red blood cells in the body.
There is also called microangiopathic hemolytic anemia. It is a condition when the red blood cells are being fragmanted. Some diseases that can cause the condition are:
- Artificial heart valve disorders.
- Uremia Hemolytic Syndrome.
- Thrombotic Thrombocytopenic Purpura (TTP).
- Disseminated Intravascular Coagulation (DIC).
In a newborn baby, there is a condition of hemolytic anemia called erythroblastosis fetalis. This condition happened due to rhesus blood type incompatibility between a pregnant woman with the fetus. If a pregnant woman has a rhesus negative blood type and the fetus’ father has a rhesus positive blood type, there is a possibility of a fetus in the womb has rhesus positive. These circumstances will cause fetal red blood cells attacked by the antibodies from the mother's body. Case of erythroblastosis fetalis generally occurs on the second pregnancy when pregnant women already have antibodies that are formed from the first pregnancy.
Hemolytic anemia disease is quite harmful for babies due to complications from the anemia. Currently, the treatment for babies who suffered erythroblastosis fetalis is by administering intravenous imunoglobulin (IVIG) or blood transfusions. Doctors also can prevent erythroblastosis fetalis on pregnant women who are diagnosed having the condition by giving injection of RhoGAM at 28th weeks of pregnancy.
The Symptoms of Hemolytic Anemia
Symptoms of hemolytic anemia are almost similar to other types of anemia. To distinguish it, further diagnosis is needed. Some symptoms of hemolytic anemia that often occur are:
- Pale skin.
- Fatigue.
- Fever.
- The head feels heavy and dizzy.
- Fatigued and unable to do heavy physical activity.
Other symptoms that may also appear on the hemolytic anemia sufferers are:
- The color of urine turns so dark.
- The skin and white part of the eyes turn yellowish.
- The heart feels swished.
- Heart rate increased.
- Enlargement of the spleen and liver.
A Diagnosis of Hemolytic Anemia
Upon physical examination, the doctor will also check of the skin color (especially if there is yellowish color on the skin or on the whites of the eyes). After that the doctor will check the patient's stomach to notice any swelling or hardening as a sign of the enlargement of the liver and the spleen organ.
If the patient is suspected of suffering hemolytic anemia, the doctor will do blood checking. Some of the parameters that are checked are as follows:
- The total number of blood cells. It is done in order to know the number of blood cells in patients.
- Bilirubin. It needs to check in order to know the number of red blood cells which are destroyed by the liver. For people who suffer hemolytic anemia, their not conjugated bilirubin concentration in their body is generally below 0.3 mg/L.
- Hemoglobin. It needs to check in order to know the number of the red blood cells that are still alive.
- Reticulocyte number. This check is done in order to find out the number of red blood cells that are produced by the body.
- The function of the liver.
Some additional tests that can help diagnosis of hemolytic anemia include:
- A urine test. It is done to detect the presence of blood cells in the urine.
- A bone marrow biopsy. This test is done to determine the number of red blood cells that are produced along with the form.
- Staining of blood (peripheral blood smear). The blood staining is used to see the shape of the blood cells via microscopic observations. Through this inspection, the doctor can determine the maturity of blood cells, blood cells fragmentation, and so on. The blood staining can also detect if a person is affected by sickle cell anemia or not based on the shape of the red blood cells.
- Study of the dehydrogenase lactate enzyme. The dehydrogenase lactate enzyme is one important indicator in determining the presence of hemolysis in patients. Patients suffering from hemolytic anemia can be diagnosed from the increase of dehydrogenase lactate serum in blood. However, some other disease malignancy (cancer) can also increase the levels of dehydrogenase lactate serum in blood.
- Study of haptoglobin serum. The reduction of haptoglobin serum in the blood can indicate the presence of hemolytic anemia in the degree of intermediate until heavy.
The Treatments of Hemolytic Anemia
- Blood transfusions. Blood transfusion is aimed to increase the number of patient’s red blood cells and replace the quickly damaged blood cells.
- Imunoglobulin intravenous (IVIG). A lack of red blood cells can cause patients become more vulnerable to infections. To prevent this, the patient will be given imunoglobulin through intravenous fluids.
- Corticosteroids. On extrinsic hemolytic anemia patients caused by autoimmune disease, corticosteroid works to suppress immune system response so that the red blood cells are not destroyed easily.
- Spleen removal surgery. The spleen is an organ which has a function to destroy red blood cells. In the case of severe hemolytic anemia which cannot be resolved by other methods of treatment, the spleen of a patient can be removed to reduce the damage of red blood cells.
For hemolytic anemia patients who have been diagnosed by a doctor, please note the following things in order to live a normal activity:
- Avoid direct contact with sick people, especially those exposed to infectious diseases.
- Avoid crowd to lower the risk of infection.
- Wash the hands regularly.
- Avoid eating raw foods.
- Brush the teeth regularly.
- Regularly have a flu vaccination every year.
Complications of Hemolytic Anemia
Some of the complications that can occur in people with hemolytic anemia are:
- The severity of the anemia increased. On intravascular hemolysis patients, iron deficiency due to chronic hemoglobinuria can worsen the anemia which already appeared.
- Jaundice.
- Heart failure.
0 Response to "Hemolytic Anemia: Causes, Symptoms, Diagnosis, Treatments and Complications"
Post a Comment