Hemolysis is the destruction of red blood cells. Hemolysis can occur due to different causes and leads to the release of hemoglobin into the bloodstream. Normal red blood cells (erythrocytes) have a lifespan of about 120 days. After they die they break down and are removed from the circulation by the spleen. In some medical conditions, or as a result of taking certain medications, this breakdown of red blood cells is increased. Red cells may break down due to mechanical damage, such as from artificial heart valves or heart-lung bypass; or they may be destroyed due to defects in the cells themselves. Medications that have been associated with hemolysis include acetaminophen, penicillin, and other pain medications. Hemolytic anemia is the term used to refer to anemia caused by the excess destruction of red blood cells.
Other causes of hemolysis
- Artificial Heart Valves
- Autoimmune Hemolytic Anemia
- Bacterial Infections
- Heart-Lung Bypass Machine
- HELLP Syndrome
- Hereditary Elliptocytosis
- Hereditary Spherocytosis
- Malignant Hypertension
- Pyruvate Kinase Deficiency
- Thrombotic Thrombocytopenic Purpura
- Transfusion Reaction
- Wiscott-Aldridge Syndrome
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
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Causes of Hemolysis
Acquired Immunodeficiency Syndrome
AIDS is the advanced stage of HIV infection. Symptoms and signs of AIDS include pneumonia due to Pneumocystis jiroveci, tuberculosis, toxoplasmosis, seizures, weakness, meningitis, yeast infection of the esophagus, and Kaposi's sarcoma. Anti-retroviral therapy (HAART) is used in the treatment of AIDS.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Beta Thalassemia is the most familiar type of thalassemia. Thalassemia is not just one disease but rather a complex series of genetic (inherited) disorders all of which involve underproduction of hemoglobin. Beta thalassemia major symptoms include pale skin, irritability, growth retardation, swelling of the abdomen, and jaundice. Beta thalassemia treatments include directly relieving the symptoms of the illness.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Cytomegalovirus (CMV) is a virus that is spread from person to person via spit, semen, vaginal secretions, urine, blood, sexual contact, breastfeeding, blood transfusions, organ transplants, and breast milk. Symptoms of CMV include fatigue, swollen glands, fever, and sore throat. You can take precautions to prevent CMV such as washing hands frequently and thoroughly and using condoms. If you work in a day care center, wash your hands thoroughly after contact with body secretions, and avoid oral contact with objects covered in saliva. Individuals with HIV infection are at most risk of contracting CMV.
Epstein-Barr Virus (EBV)
The Epstein-Barr virus (EBV) is a common cause of mononucleosis (viral pharyngitis). Symptoms and signs of an EBV infection include swollen lymph nodes, fever, rash, sore throat, malaise, and a swollen liver and/or spleen. Treatment focuses on reducing the severity of the symptoms and signs. There is no vaccine to prevent EBV infections.
G6PD deficiency (Glucose 6-phosphate dehydrogenase) leads to a condition called hemolytic anemia. Causes of G6PD deficiency is an abnormal gene located in the X-chromosome, therefore, it is more common in males. Hemolytic anemia caused by G6PD deficiency generally occurs after exposure to malaria medications, antiitching drugs, and fava beans. Pneumonia and other infections can also precipitate hemolytic anemia in individuals with G6PD deficiency. Treatment is generally discontinuing the drug or compound treating infection. Blood transfusions are necessary in some individuals.
Hemolytic Uremic Syndrome
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include: E. coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include: gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes: medical history, physical examination, and medical tests. Treatment includes: rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Hepatitis (Viral Hepatitis, A, B, C, D, E, G)
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Human Immunodeficiency Virus (HIV)
The human immunodeficiency virus (HIV) causes HIV infection and the acquired immunodeficiency syndrome (AIDS). Symptoms and signs of HIV infection include fatigue, enlarged lymph glands, and recurrent vaginal yeast infections. Highly active antiretroviral therapy (ART) is the standard treatment for HIV infection.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Lupus (Systemic Lupus Erythematosus or SLE)
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Non-Hodgkin's lymphoma is cancer of the lymphatic system, a vital part of the body's immune system. Symptoms and signs include swollen lymph nodes, fever, night sweats, coughing, weakness, chest pain, unexplained weight loss, and abdominal pain. Treatment depends on which type of non-Hodgkin's lymphoma one has, the stage of the cancer, one's age, how fast the cancer is growing, and whether one has other health problems.
Pneumonia is inflammation of the lungs caused by fungi, bacteria, or viruses. Symptoms and signs include cough, fever, shortness of breath, and chills. Antibiotics treat pneumonia, and the choice of the antibiotic depends upon the cause of the infection.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
Sickle Cell Disease (Sickle Cell Anemia)
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is caused by an inherited abnormal hemoglobin. Symptoms of sickle cell anemia may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
Examples of Medications for Hemolysis
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