HEMOLYTIC ANEMIA
CAUSES OF
HEMOLYTIC ANEMIA
The immediate cause of hemolytic anemia is the early destruction of red blood cells.
Red
blood cells are destroyed and removed from the bloodstream before their normal
lifespan is over.
causes
can be inherited or acquired.
Sometimes,not
known.
Inherited
Hemolytic Anemias
You
can get a faulty red blood cell gene from one or both of your parents.
Different
types of faulty genes cause different types of inherited hemolytic anemia.
,
in each type, the body makes abnormal red blood cells.
The defect may involve the hemoglobin, cell
membrane, or enzymes that maintain healthy red blood
cells.
The
abnormal cells are fragile and break down while moving through the bloodstream.
In
condition spleen removes the cell debris from the bloodstream.
Conditions
causing
Sickle cell anemia (painful occlusive
crisis)
Thalassemia
G6 PD deficiency
Acquired
Hemolytic Anemias
In
acquired hemolytic anemias, the body makes normal red blood cells.
However,
a disease, condition, or other factor destroys the cells.
conditions
that can destroy the red blood cells include:
Auto Immune disorders e.g.Lupus,Wiskott-Aldrich
syndrome
Infections
Blood transfusion
Hypersplenism
Infection:E.coli,EB
virus,Streptococcus,Typhoid fever
Tumor
Leukemia
Lymphoma
Reactions
to medicines –Acetaminophene,penicillin,methicillin,Chlorpromazine.Ibuprofen
interferonAlpha,procainamide.quinine,
Who Is at Risk for
Hemolytic Anemia?
Age
and sex incidence:all ages and races and both sexes.
Some types of hemolytic anemia are more likely
to occur in certain populations than others.
For
example, glucose-6-phosphate
dehydrogenase (G6PD) deficiency mostly affects males of African or
Mediterranean descent.
In the United States, the condition is more
common among African Americans than Caucasians.
In
the United States,sickle cell anemia mainly affects African Americans
Signs and Symptoms of Hemolytic Anemia
**************************************
---------------
SIGNS AND SYMPTOMS OF HEMOLYTIC ANEMIA
The signs and symptoms of hemolytic anemia will depend on
the type and severity of the disease.
mild hemolytic
anemia no signs or symptoms.
More severe cases
-many signs and symptoms, and may be serious.
Many of the signs and symptoms of hemolytic anemia apply to
all types of anemia
Signs and Symptoms of
Anemia
The most common symptom of all types of anemia is fatigue
(tiredness).
Fatigue becauseof reduced oxygen carrying capacity due to fall in RBC count
A low red blood cell count also can causedyspnea, dizziness,
headache, coldness in
hands and feet, pale skin, and chest pain.
Because of lack of
red blood cells that heart has to work harder
. This can lead to arrhythmia, heart murmur an enlarged heart, Heart failure.
Signs and Symptoms of Hemolytic Anemia
- Jaundice
The hemoglobin is broken down into the compound bilirubin, which gives the skin and eyes a
yellowish color. urine becomes dark yellow or brown.
- Pain in the Upper Abdomen
High levels of
bilirubin and cholesterol (from the breakdown of red blood cells) can form into
stones in the gallbladder. These stones can be painful.
The spleen helps fight infection and filters out old or
damaged blood cells. In hemolytic anemia, the spleen may be enlarged, which can
be painful.
- Leg Ulcers and Pain
As Reaction to incompatible blood transfusion:
One may develop hemolytic
anemia due to a blood transfusion. Signs and symptoms of a severe reaction
to a transfusion include fever, chills, hypotension and shock..
Physical Exam and Investigations
Aim;To Find out how severe the condition is and what's causing it.
Physical exam includes:
- Checking for jaundice
- Examine for rapid or irregular heartbeats
- Check for rapid or uneven
breathing
- check the size of spleen
- pelvic and rectal exam to check
for internal bleeding
Diagnostic Tests and Procedures
Tests to confirm the
diagnosis, cause and find the severity.
1.complete blood count(CBC).
2. Also check
hemoglobin and hematocrit levels.
.The
normal range of these levels may vary in certain racial and ethnic populations.
3.Look at
mean corpuscular volume (MCV-.
,MCV is a
measure of the average size of red blood cells. (A clue as to the cause of
anemia.)
Other Blood Tests
If the CBC
results confirm anemia, other blood tests are done to find out what type of anemia patient has and
how severe it is.
Reticulocyte count. A reticulocyte count measures the
number of young red blood cells in blood. The test shows whether bone marrow is
making red blood cells at the correct rate.
People who
have hemolytic anemia usually have high reticulocyte counts because their bone
marrow is working hard to replace the destroyed red blood cells.
Peripheral smear.: Some types of hemolytic anemia
change the normal shape of red blood cells.
Coombs' test. This test can show whether body is
making antibodies (proteins) to destroy red blood cells.
Haptoglobin
Normlly when red blood cells break down, they
release hemoglobin into the bloodstream.
The
hemoglobin combines with haptoglobin.
A low
level of haptoglobin in the bloodstream is a sign of hemolytic anemia.
Bilirubin, and liver function tests
Hemoglobin
is broken down into bilirubin. High levels of bilirubin in the bloodstream may
be a sign of hemolytic anemia. High levels of this compound also occur with
some liver and gallbladder diseases.
liver
function tests: to find out what's causing the high bilirubin
levels.
Hemoglobin electrophoresis.
This test looks at the different types of
hemoglobin in blood.
It can help diagnose the type of anemia.
Test for paroxysmal nocturnal
hemoglobinuria (PNH).
In PNH, the red blood cells are missing
certain proteins. The test for PNH can detect red blood cells that are missing
these proteins.
Osmotic fragility test. To look for red blood cells those are more
fragile than normal. These cells may be a sign of hereditary spherocytosis (an
inherited type of hemolytic anemia).
Testing for glucose-6-phosphate
dehydrogenase (G6PD) deficiency
In G6PD deficiency, the red blood cells are
missing an important enzyme called G6PD
.. Bone Marrow Tests
Bone marrow tests to show whether bone marrow is healthy and making
enough blood cells. The two bone marrow tests are aspiration and biopsy.
bone marrow aspiration:, Removal a small amount of fluid bone marrow
through a needle. The sample is examined under a microscope to check for faulty
cells.
bone marrow biopsy may be done at the same time as an aspiration
or afterward removal ofsmall amount of bone marrow tissue through a needle. The
tissue is examined to check the number and type of cells in the bone marrow.
Patient may not need
bone marrow tests if blood tests show what's causing hemolytic anemia.
Tests for Other Causes of Anemia
Because
anemia has many causes, also tests for conditions such as:
Kidney
failure
Lead
poisoning
Vitamin or
iron deficiency
Newborn Testing for Sickle Cell Anemia and G6PD Deficiency
This test is mandatory as
part of newborn screening programs. Most States also mandate screening for G6PD
deficiency. These inherited types of hemolytic anemia can be detected with
routine blood tests.
Diagnosing these
conditions as early as possible is important for earliest treatment.
TREATMENT
Treatments for hemolytic anemia include
·
Blood transfusions
·
medicines,
·
plasmapheresis
·
surgery,
·
blood and marrow stem
cell transfusion and
·
lifestyle changes.
People who have mild
hemolytic anemia may not need treatment, as long as the condition doesn't
worsen.
People who have severe
hemolytic anemia usually need ongoing treatment. Severe hemolytic anemia can be
fatal if it's not properly treated.
Goals of
Treatment
The goals of treating hemolytic anemia include:
Reducing or stopping the destruction of red blood cells
Increasing the red blood cell count to an acceptable
level
Treating the underlying cause of the condition
Treatment will depend on
the type,
cause,
and severity
Also to considered are age, overall health,
and medical history.
In inherited form of hemolytic anemia,
it's a lifelong condition that may require ongoing treatment.
an acquired form
of hemolytic anemia,may be cured by treating the cause.
Blood Transfusions
Blood transfusions are used to treat severe or
life-threatening hemolytic anemia.
.
DRUGS
Medicines can
improve some types of hemolytic anemia, especially autoimmune hemolytic anemia (AIHA).
Corticosteroids,
such as prednisone, can stop immune
system from, or limit its ability to, make antibodies against red blood cells.
If there is no response to corticosteroids, other immunosuppressive drugs are used.
Examples include the medicines rituximab and
cyclosporine.
For severe sickle
cell anemia -hydroxyurea.
This medicine body to make fetal hemoglobin.
In sickle cell anemia, fetal hemoglobin helps prevent red
blood cells from sickling and improves anemia.
Plasmapheresis
Plasmapheresis is a procedure that removes antibodies
from the blood. For this procedure, blood is taken from the body using a needle
inserted into a vein.
The plasma,
which contains the antibodies, is separated
from the rest of the blood. Then, plasma from a donor and the rest of the blood
is put back in the body.
This treatment may help if other treatments for immune
hemolytic anemia don't work.
Surgery
Some people who have hemolytic anemia may need surgery to
remove their spleens.
An enlarged or diseased spleen may remove more red blood
cells than normal, causing anemia. Removing the spleen can stop or reduce high
rates of red blood cell destruction.
Blood and Marrow
Stem Cell Transplant
In thalssemia
bone marrow doesn't make enough healthy red blood cells. The red blood cells it
does make may be destroyed before their normal lifespan is over.
Blood and marrow
stem cell transplants may be used to treat these types of hemolytic anemia.
A blood and marrow stem cell transplant replaces damaged
stem cells with healthy ones from a donor.
During the transplant, which is like a blood
transfusion, donated stem cells given intra -venously. Once the stem cells are
in the body, they travel to bone marrow and begin making new blood cells.
Lifestyle Changes
If patient has AIHA with cold-reactive
antibodies, patient must try to avoid
cold temperatures. This can help prevent the breakdown of red blood cells. It's
very important to protect fingers, toes, and ears from the cold.
To protect himself , patient can:
- Wear
gloves or mittens when taking food out of the refrigerator or freezer.
- Wear
a hat, scarf, and a coat with snug cuffs during cold weather.
- Turn
down air conditioning or dress warmly while in air-conditioned spaces.
- Warm
up the car before driving in cold weather.
People born with glucose-6-phosphate dehydrogenase
(G6PD) deficiency can avoid substances
that may trigger anemia. For example, avoid fava beans, naphthalene (a
substance found in some moth balls), and certain medicines
How Can Hemolytic Anemia Be Prevented?
1.. Inherited types of hemolytic anemia cannot be
prevented.
One exception is glucose-6-phosphate dehydrogenase (G6PD)
deficiency.
2.If patient is born with G6PD deficiency, he can avoid
substances that may trigger the condition. For example, avoid fava beans,
naphthalene (a substance found in some moth balls), and certain medicines
3.Some types of acquired hemolytic anemia can be
prevented.
Reactions to blood
transfusion, which can cause hemolytic anemia, can be prevented. This requires
careful matching of blood types between the blood donor and the recipient
.
4.Prompt and proper prenatal care can help one avoid the problems of RH incompatibility..
Rh incompatibility
can lead to hemolytic anemia in a fetus or newborn.
Key Points
- Hemolytic anemia is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.
- Hemolytic anemia is a type of anemia. The term "anemia" usually refers to a condition in which your body has a lower than normal number of red blood cells.
- Anemia has three main causes: blood loss, lack of red blood cell production, or high rates of red blood cell destruction. Hemolytic anemia is caused by high rates of red blood cell destruction.
- Hemolytic anemia can lead to many health problems, such as fatigue (tiredness), pain, arrhythmias(irregular heartbeats), an enlarged heart, and heart failure
- There are many types of hemolytic anemia. The condition can be inherited or acquired.
- With inherited hemolytic anemias, one or more of the genes that control red blood cell production are faulty. This causes your bone marrow to make abnormal red blood cells that die or are destroyed too quickly.
- With acquired hemolytic anemias, another disease or factor causes body to destroy red blood cells and remove them from the bloodstream.
- Hemolytic anemia can affect people of all ages and both sexes. Some types of the condition are more likely to occur in certain populations than in others.
- Signs and symptoms will depend on the type of hemolytic anemia and how severe it is. People who have mild hemolytic anemia often have no signs or symptoms. More severe hemolytic anemia may cause many signs and symptoms, and they may be serious.
- Signs and symptoms may include fatigue, shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, jaundice (a yellowish color of the skin or whites of the eyes), pain in the upper abdomen, leg ulcers and pain, and a severe reaction to a blood transfusion
- Diagnosis of hemolytic anemia is based on medical and family histories, a physical exam, and test results.
- Treatment for hemolytic anemia depends on the type and severity of the condition. Treatments may include blood transfusions, medicines, plasmapheresis, surgery blood and marrow stem cell transplantation, and lifestyle changes. People who have mild hemolytic anemia may not need treatment, as long as the condition doesn't worsen.
- usually can't prevent inherited types of hemolytic anemia, but you may be able to prevent some types of acquired hemolytic anemia.
- .Check regularly for ongoing care. Follow treatment plan and make lifestyle changes as recommended.
- If your child has hemolytic anemia, talk with his or her health care team about treatment, diet, and appropriate physical activities.
---------------
0 comments:
Post a Comment