Hemolytic Anemias in Red Blood Cells

Basically there are three ways by which anemia can occur, blood loss, increased destruction of RBCs, and decreased production of RBCs.

There are more than 2(K) known causes of hemolysis. The life span of red blood cells (RBCs) is about 90 to 120 days in vivo. The life span of RBCs is shortened in a number of disorders due to hemolysis. If the bone marrow is unable to adequately replenish the prematurely destroyed RBCs, hemolytic anemia results.

The hemolytic disease is broadly classified into inherited or acquired hemolytic disorders. In most of the acquired hemolytic disorders, RBCs production in the bone marrow is normal, and the RBCs are destroyed prematurely after their release into the circulation. (However, rare diseases characterized by acquired dysplasia of the bone marrow cells and the production of structurally and functionally abnormal RBCs are exceptions.) Acquired hemolytic anemia may occur due to immune disorders, toxic chemicals, drugs, and physical damage.
 

i. Careful history taking and physical examination provide important clues to the diagnosis of hemolytic anemia.

ii. An increase in reticulocyte count in a patient with anemia is a useful indicator of hemolysis.

iii. The morphology of RBCs seen in the peripheral blood smear may provide evidence of hemolysis as well as its cause.

iv. The serum level of unconjugated (indirect) bilirubin may be increased and result in apparent jaundice. Jaundice is usually detectable when serum bilirubin is >34 n.mol/L or >2 mg/ dL.

v. Serum haptoglobin level is decreased or absent. Hemolysis is associated with the release of hemo­globin and lactic acid dehydrogenase (LDH). The hemoglobin released from the lysed RBCs leads to an increase in serum indirect (unconjugated) bilirubin and urobilinogen in the urine.

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