Hemolysis, or hemolytic anemia, is a destruction of red blood cells due to a variety of possible causes that is difficult to prevent and treat, and in severe cases can often lead to death.
What is hemolysis?
Hemolysis is a condition that causes red blood cells, called erythrocytes, to break down. By damaging the cell membrane of the erythrocytes, the hemoglobin, which is the pigment of the red blood cells, passes into the plasma, which is actually colorless. A distinction is made between so-called physiological hemolysis and increased hemolysis. In the first case, this is a natural death of the erythrocytes after 120 days. The second case describes an increased dissolution of erythrocytes that goes beyond the natural erythrocyte cycle and must be considered pathological.
Causes
There are many causes of hemolysis. Hemolysis that occurs may be a symptom of another underlying disease or may occur equally as a result of mechanical processes or may be genetic. Thus, hemolysis can occur as a result of severe infections and autoimmune diseases, as well as poisoning, prosthetic heart valves and burns, or defects in erythrocyte membranes or hemoglobin. Parasites may also be a possible cause of increased hemolysis. An initial indication of pathological hemolysis is brown discolored urine. The discoloration is due to the fact that increased hemoglobin is excreted in the urine during increased hemolysis (see also blood in the urine). A doctor may perform several tests if increased hemolysis is suspected. If an increased number of young erythrocytes can be detected in the blood with a simultaneous lower concentration of hemoglobin, this is another indication of possible hemolysis. So-called Coombs tests help to diagnose a disease with certainty. However, increased hemolysis is not always detected immediately.
Symptoms, complaints, and signs
Classic symptoms of hemolysis include tremors, fatigue, poor concentration, headache, dizziness, and shortness of breath to palpitations under stress. The characteristic pallor of the skin is accompanied by other symptoms of jaundice. Thus, abdominal pain, fever and a general feeling of malaise occur, often accompanied by severe fatigue. Many patients also experience chills and headaches. If a hemolytic crisis occurs, symptoms such as severe stomach pain, high [[fever9]], and 8[circulatory distress]] may occur. In severe cases, circulatory collapse occurs. Gallstones often form and enlargement of the spleen occurs, which may add other symptoms. In a severe course, thrombosis develops or renal failure occurs. Hemolytic anemia can also occur and become noticeable through the typical signs of anemia. If hemolysis is not adequately treated, loss of consciousness may occur. The symptoms usually appear a few days to weeks after the causative disease and persist for months or even years. In some patients, the symptoms resolve on their own once the trigger has been removed. In other cases, hemolysis is fatal.
Diagnosis and course
Various complications may occur as a result of increased hemolysis: As a comparatively harmless cause, gallstones may develop due to hemolysis. In the worst case, however, thrombosis, renal failure, or hemolytic anemia may occur. In this case, more erythrocytes are destroyed than can be regenerated, in contrast to a healthy body, which is able to constantly regenerate new erythrocytes, so that in physiological hemolysis the number of erythrocytes in the blood remains constant. In the further course, there may be an insufficient oxygen supply to the tissue. Because of the many possible complications, in quite a few cases hemolysis can become chronic and even lead to death.
Complications
In the worst case, hemolysis can lead to the death of the patient. In this case, the red blood cells are destroyed, resulting in various symptoms and limitations. The affected person feels sick and tired and suffers from severe fatigue.Furthermore, jaundice may also occur, in which the patient also suffers from fever and abdominal pain. The patient may lose consciousness and complains of severe headaches and nausea. As a rule, it is no longer possible to perform any particular physical activities, so that there is a severe restriction in the patient’s life. The enlargement of the spleen continues to cause severe pain in the abdominal region. In the worst case, renal insufficiency can develop, in which the patient is dependent on a donor kidney or dialysis. If the symptoms are not treated, the patient usually dies. Treatment is always causal and takes the form of surgery. Complications rarely occur if the operation is performed at an early stage. Life expectancy may be reduced if hemolysis is treated late.
When should you see a doctor?
Symptoms such as fatigue, tiredness, and jaundice indicate hemolysis. If these signs appear for seemingly no reason and do not resolve on their own, medical advice is needed. Patients who suddenly suffer from gallstones or signs of splenomegaly should seek medical attention. If external signs of illness such as pallor and sunken eyes become apparent, the family physician must be consulted. If there are signs of a hemolytic crisis, which may be manifested by fever and abdominal pain, for example, the emergency physician is the right person to contact. The same applies to kidney failure, thrombosis or hemolytic anemia. Hemolysis is triggered by severe infections and autoimmune diseases. Poisoning, burns or autoimmune diseases are also among the possible causes. Those who belong to these risk groups must immediately talk to the responsible physician in case of the mentioned symptoms. In case of severe symptoms, it is best to go to the nearest hospital or the ambulance service should be called immediately. Since hemolysis can recur repeatedly, regular check-ups by the family doctor or an internist are indicated.
Treatment and therapy
In order to treat pathological hemolysis efficiently, it must first of all be determined whether the hemolysis is congenital or due to some other cause. If the hemolysis is due to another disease, the hemolysis usually disappears with treatment of the underlying disease. For the duration of recovery, to avoid an increase in hemolysis, a transfusion of red cell concentrates may be necessary. If the hemolysis is due to genetic causes, the only treatment that often remains is surgery to remove the spleen. The same treatment is often given if the hemolysis has occurred because the respective immune system of the affected person has itself produced antibodies that are responsible for the destruction of the erythrocytes, and drug treatment is not or no longer sufficient. In case of mechanical causes, to treat hemolysis logically the cause must be stopped. In the worst case, hemolysis to which a prosthetic heart valve is subject may necessitate replacement of the prosthesis. Blood transfusions are often not appropriate for treating hemolysis.
Prevention
Hemolysis is difficult to prevent and can only be prevented under certain circumstances, such as not having a genetic predisposition to hemolysis. Low-risk behaviors, such as protection from possible intoxication or autoimmune disease, are often the only ways to protect against hemolysis.
Follow-up
During the follow-up and recovery phase of hemolysis, transfusion may be initiated to provide red blood cell concentrates to patients. Doctors use this to alleviate the condition. When genetic causes are present, physicians often opt for surgical removal of the spleen because treatment with medications does not produce satisfactory results. Patients can change their lifestyle in the ensuing phase to minimize the risk of intoxication. A healthy lifestyle is an effective way of strengthening the immune system and limiting the risk of autoimmune diseases. This improves protection against hemolysis. Furthermore, patients should watch for discoloration in the urine, which may indicate the disease.In the event of abnormalities, a doctor’s appointment should be arranged at short notice. The subsequent diagnostics will show whether the change is related to the disease. Those affected can protect themselves from the symptoms by adopting a balanced diet and lifestyle. Patients at risk should avoid alcohol and stimulants such as coffee and nicotine, otherwise their general condition will deteriorate. Depending on the situation and fitness status, a gentle to moderate exercise program that stimulates the circulation, stabilizes the immune system and reduces excess weight is useful.
Here’s what you can do yourself
Hemolysis is a serious disease of the blood that the affected patient can neither self-diagnose nor self-treat. It is often noticeable by a dark discoloration of the urine. However, there may be other causes for the discoloration of the urine. If the patient observes such discoloration, he should immediately consult his physician and have appropriate diagnostics performed. Accompanying symptoms of hemolysis are a feeling of faintness and fatigue as well as sometimes severe headaches, which are caused by the disturbed metabolism. Treatment of hemolysis is carried out in consultation with the physician and with regular checks. It is very important that the patient adheres to the discussed treatment plan and attends the examinations. In order to support the treatment, the patient should refrain from all things and habits that lead to strain on the organism and, consequently, to weakening. Ideally, during the treatment of hemolysis, the patient strives for a healthy and balanced lifestyle. Pleasure toxins such as alcohol, coffee in large quantities, nicotine or drugs should be urgently avoided. Depending on the general condition of the patient, a light to moderate exercise or sports program can strengthen the immune system and the cardiovascular system. In this way, the organism is supported in its recovery. Excess weight should be reduced.