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Hemolytic anemia
Classification and external resources
ICD-10 D55.-D59.
ICD-9 282, 283, 773
DiseasesDB 5534
MedlinePlus 000571
eMedicine med/979 
MeSH D000743

Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Hemolysis (or haemolysis)—from the Greek Hemo-, Greek meaning blood - Lysis, meaning to break open—is the breaking Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood The blood vessels are part of the Circulatory system and function to transport Blood throughout the body It has numerous possible causes, ranging from relatively harmless to life-threatening. The general classification of hemolytic anemia is either acquired or inherited. Treatment depends on the cause and nature of the breakdown.

In a healthy person, a red blood cell survives 90 to 120 days (on average) in the circulation, so about 1% of human red blood cells break down each day. The spleen (part of the reticulo-endothelial system) is the main organ which removes old and damaged RBCs from the circulation. The spleen is an organ found in all Vertebrate animals In humans the spleen is located in the abdomen of the body where it functions in the destruction of redundant Red The reticuloendothelial system ( RES) part of the Immune system, consists of the phagocytic cells located in Reticular connective tissue, primarily In healthy individuals, the break down and removal of RBCs from the circulation is matched by the production of new RBCs in the bone marrow. Bone marrow is the flexible tissue found in the hollow interior of Bones In adults marrow in large bones produces new Blood cells It constitutes 4% of

In conditions where the rate of RBC breakdown is increased, the body initially compensates by producing more RBCs; however, breakdown of RBCs can exceed the rate that the body can make RBCs, and so anemia can develop. Bilirubin, a breakdown product of hemoglobin, can accumulate in the blood causing jaundice, and be excreted in the urine causing the urine to become a dark brown colour. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes

Contents

Symptoms

Signs of anemia are generally present (fatigue, later heart failure). Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Jaundice may be present.

Tests

Clinical findings in haemolytic anaemias: 1. increased serum bilirubin levels in blood, therefore jaundice 2. pallor in mucous membrane and skin 3. increased urobilinogen in urine. . urine turns dark on standing 4. Splenomegaly 5. Pigmented gallstones may be found

Classification of hemolytic anemias

Causes of hemolytic anemia can be either genetic or acquired.

Genetic

Acquired

Acquired hemolytic anemia can be further divided into immune and non-immune mediated. Hereditary spherocytosis is a genetically-transmitted form of Spherocytosis, an auto- hemolytic Anemia characterized by the production of red blood cells Hereditary elliptocytosis is a blood disorder in which a large proportion of the sufferer's Erythrocytes (i Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive Hereditary disease characterised by abnormally low levels of Glucose-6-phosphate Pyruvate kinase deficiency, also called erythrocyte piruvate kinase deficiency, is an Inherited Metabolic disorder of the enzyme Pyruvate kinase Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Thalassemia (from Greek θαλασσα thalassa sea + αίμα haima blood British spelling "thalassaemia" is an inherited Autosomal recessive

Immune mediated hemolytic anemia (direct Coombs test is positive)

Non-immune mediated hemolytic anemia (direct Coombs test is negative)

Drug induced hemolysis

Drug induced hemolysis has large clinical relevance. A snake is an elongate Reptile of the suborder Serpentes Like all reptiles snakes are covered in scales. In Anatomy, the heart valves are Valves in the Heart that maintain the unidirectional flow of blood by opening and closing depending on the difference In Medicine ( Hematology) microangiopathic hemolytic anemia (MAHA is a microangiopathic subgroup of Hemolytic anemia ( Anemia, loss Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including Babesiosis is a malaria-like Parasitic disease caused by Babesia, a Genus of Protozoal piroplasms Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused Paroxysmal nocturnal hemoglobinuria (PNH sometimes referred to as Marchiafava-Micheli syndrome, is a rare acquired potentially life-threatening disease of the blood characterised Liver disease is a broad term describing any number of Diseases affecting the Liver. It occurs when drugs actively provoke red blood cell destruction. Four mechanisms are described below.

Immune

Penicillin in high doses can induce immune mediated hemolysis via the hapten mechanism in which antibodies are targeted against the combination of penicillin in association with red blood cells. Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections A hapten is a Small molecule which can elicit an immune response only when attached to a large carrier such as a Protein; the carrier may be one which also does not Complement is activated by the attached antibody leading to the removal of red blood cells by the spleen.

The drug itself can be targeted by the immune system, e. g. by IgE in a Type I hypersensitivity reaction to penicillin, rarely leading to anaphylaxis.

Non-immune

Non-immune drug induced hemolysis can occur via oxidative mechanisms. This is particularly likely to occur when there is an enzyme deficiency in the antioxidant defence system of the red blood cells. An example is where antimalarial oxidant drugs like primaquine damage red blood cells in Glucose-6-phosphate dehydrogenase deficiency in which the red blood cells are more susceptible to oxidative stress due to reduced NADPH production consequent to the enzyme deficiency. Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive Hereditary disease characterised by abnormally low levels of Glucose-6-phosphate

Some drugs cause RBC (red blood cell) lysis even in normal individuals. These include dapsone and sulfasalazine. Dapsone (diamino-diphenyl sulfone is an pharmacological Medication most commonly used in combination with Rifampicin and Clofazimine as multidrug Sulfasalazine (brand name Azulfidine in the US, Salazopyrin in Europe) is a Sulfa drug, a derivative of Mesalazine

Non-immune drug-induced hemolysis can also arise from drug-induced damage to cell volume control mechanisms; for example drugs can directly or indirectly impair regulatory volume decrease mechanisms, which become activated during hypotonic RBC swelling to return the cell to a normal volume. Tonicity is a measure of blood capacity or effective osmolality in cell Biology. The consequence of the drugs actions are irreversible cell swelling and lysis (e. g. ouabain at very high doses). Ouabain ('waben wa'bein (through French from Somali 'waabaayo' an arrow poison is the familiar name of g-strophanthin a poisonous Cardiac glycoside.

Differential diagnosis

Therapy

Definitive therapy depends on the cause.

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