American Medical Association Family Medical Guide - American Medical Association [369]
Symptoms
The main symptoms of hemolytic anemia are fatigue, shortness of breath, and palpitations (heartbeats that you’re aware of), especially during physical activity. Your skin may be pale yellow and your urine may contain blood pigment that makes it look darker than usual. If red blood cells are destroyed prematurely over a period of years, gallstones (see page 793) often form from a buildup of bilirubin, a protein by-product of the breakdown of red blood cells.
Diagnosis
Hemolytic anemia is diagnosed with blood tests that look for by-products of red blood cell damage such as bilirubin. Examination of the blood provides valuable information about the shape of the red blood cells, because many types of hemolysis produce abnormally shaped red cells. The spleen may be enlarged from working harder than usual. The blood may be tested for antibodies as well as abnormal types of hemoglobin such as those that occur in sickle cell disease or thalassemia (see previous page).
Treatment
The treatment for some types of hemolytic anemia is a splenectomy, a surgical procedure to remove the spleen. Splenectomy may be used to treat hemolytic anemia caused by an errant immune response and the hereditary form of hemolytic anemia because the spleen produces the antibodies that destroy red blood cells and is the major site of red cell destruction. However, doctors frequently prescribe corticosteroid medications, which may eliminate the need for a splenectomy. Corticosteroids dampen the abnormal immune response that causes the spleen to produce antibodies against red blood cells. Corticosteroids also inhibit the abnormal destruction of red blood cells by the spleen and other parts of the immune system. Doctors may also prescribe immune-suppressing drugs to decrease the immune system’s production of antibodies, which can mistakenly attack and destroy red blood cells. If hemolytic anemia is triggered by a medication a person is taking, the doctor will ask him or her to stop taking the drug.
Bleeding and Bruising
Bleeding occurs when a blood vessel is damaged. If an internal blood vessel is injured, blood seeps into surrounding tissue and forms a bruise. When delicate blood vessels are just beneath the surface, such as in the nose, a minor injury or irritation can cause external bleeding. In most people, minor bleeding does not cause problems because three mechanisms in the body quickly act together to stop the bleeding. First, nearby blood vessels contract and restrict the flow of blood to the injured area. Platelets (cell fragments that enable blood to clot) then gather where the blood vessels are damaged and stick to the vessel walls and to each other to form a plug. Interlacing strands of a substance called fibrin form in the damaged area; blood cells become trapped in the fibrin mesh and form a blood clot that seals the wound and stops the bleeding.
Bruising
If blood from an internal injury seeps into surrounding tissue, it forms a bruise. Once the internal bleeding has stopped, white blood cells called monocytes go to the injured area and help break down the red blood cells, healing the bruise.
In most diseases in which abnormal bleeding occurs (such as hemophilia), one or more of the mechanisms that normally stop bleeding malfunction. Minor injuries can cause persistent or severe bleeding. In a person with hemophilia or another bleeding disorder, bleeding from a cut, which in most people stops within 5 or 10 minutes, may continue for hours or even days. A person with a bleeding disorder may have internal bleeding and bleeding in the joints that can cause severe pain and can damage