From the Guidelines
Hemolytic anemia can be categorized into inherited and acquired types, with inherited types including sickle cell anemia, thalassemias, hereditary spherocytosis, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and pyruvate kinase deficiency, as noted in a study published in the American Journal of Hematology in 2019 1. The acquired types include autoimmune hemolytic anemia, mechanical hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and drug-induced hemolytic anemia. Some key points to consider in the diagnosis and management of hemolytic anemia include:
- The clinical manifestations of pyruvate kinase deficiency, a type of inherited hemolytic anemia, can vary widely and may include symptoms such as jaundice, fatigue, and shortness of breath, as described in a study published in the American Journal of Hematology in 2019 1.
- The diagnosis of hemolytic anemia often involves a combination of laboratory tests, including a complete blood count, reticulocyte count, and tests for autoimmune disorders or infections, as outlined in a study published in the Journal of Clinical Oncology in 2018 1.
- Treatment for hemolytic anemia depends on the underlying cause and may include medications, blood transfusions, or splenectomy, as noted in a study published in the Journal of Clinical Oncology in 2021 1.
- It is essential to consider the potential for iron deficiency and anemia of chronic disease in patients with inflammatory conditions, such as inflammatory bowel disease, as discussed in a study published in the Journal of Crohn's and Colitis in 2015 1.
- A comprehensive approach to evaluating anemia, including morphologic and kinetic assessments, can help identify the underlying cause and guide treatment, as described in a study published in the Journal of the National Comprehensive Cancer Network in 2012 1.
From the Research
Types of Hemolytic Anemia
- Hereditary abnormalities, which are intrinsic and inherited, except for Paroxysmal Nocturnal Hemoglobinuria (PNH) 2
- Acquired abnormalities, which are extrinsic and include factors such as antibodies, physical trauma, biological agents, chemical agents, and physical agents 2
- Hemoglobinopathies, which are disorders that affect the structure or production of hemoglobin, such as sickle cell disease and thalassemia 3, 4, 5
- Membranopathies, which are disorders that affect the red blood cell membrane, such as hereditary spherocytosis 3
- Enzymopathies, which are disorders that affect the enzymes within red blood cells, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency 3, 4, 6, 5
- Immune-mediated anemias, which are caused by the immune system attacking and destroying red blood cells 3
- Extrinsic nonimmune causes, which include thrombotic microangiopathies, direct trauma, infections, systemic diseases, and oxidative insults 3
Classification of Hemolytic Anemia
- Based on the mechanism of hemolysis, which can be intravascular, extravascular, or both 3
- Based on the underlying cause, which can be hereditary or acquired 2
- Based on the laboratory test results, which can include reticulocytosis, increased lactate dehydrogenase, increased unconjugated bilirubin, and decreased haptoglobin levels 3
Diagnosis of Hemolytic Anemia
- Anti-globulin test to determine the presence of antibodies against red blood cells 2
- Morphological observation of red blood cells to identify abnormal shapes or structures 2, 3
- Analysis of hemoglobin to diagnose hemoglobinopathies 2, 3
- Red cell enzyme assay to diagnose enzymopathies, such as G6PD deficiency 2, 6
- Screening tests for PNH to diagnose this rare disorder 2