Hemolytic Anemia: Causes

Pathogenesis (disease development)

Hemolytic anemia is caused by premature and increased breakdown of erythrocytes (red blood cells). In this process, due to a wide variety of causes (see below), increased breakdown occurs in the spleen, and later in the liver and bone marrow. If these degradation sites are also overloaded, intravascular (within a vessel) hemolysis (dissolution of red blood cells) occurs. Compensatory stimulation of hematopoiesis (blood formation) occurs in the bone marrow. Thalassemias are quantitative disorders of globin chain synthesis. Depending on the chain affected, one speaks of an α-, β-, γ-, or δ-thalassemia.

Etiology (causes)

Biographic causes

  • Genetic burden
    • Genetic diseases
      • Congenital erythrocyte enzyme defects, as in pyruvate kinase deficiency or glucose-6-phosphate dehydrogenase deficiency
      • Congenital membrane defects of erythrocytes (red blood cells) such as spherocytosis (spherocytosis).
      • Rhesus incompatibility of the newborn – blood group incompatibility between mother and child, where the mother is Rhesus negative and the child is Rhesus positive.
      • Sickle cell anemia (med.: drepanocytosis; also sickle cell anemia, sickle cell anemia) – genetic disease with autosomal recessive inheritance affecting erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin called sickle cell hemoglobin, HbS).
      • Thalassemia – disease caused by a congenital disorder of hemoglobin synthesis.
      • Wilson’s disease (copper storage disease) – autosomal recessive inherited disease in which one or more gene mutations disrupt copper metabolism in the liver.

Behavioral causes

  • Physical activity
    • Intense jogging or intense marches

Causes related to disease

  • Rejection after kidney transplantation.
  • Bartonellosis – infectious disease that occurs mainly in South America and is caused by the bacterium Bartonella bacilliformis.
  • Disseminated intravascular coagulation (DIC) – systemic disease that occurs after strong activation of coagulation, leading simultaneously to bleeding and excessive blood clotting.
  • Eclampsia (pregnancy poisoning).
  • Hemangiomas – benign tumor caused by the proliferation of blood vessels.
  • Hemolytic uremic syndrome (HUS) – triad of microangiopathic hemolytic anemia (MAHA; form of anemia in which erythrocytes (red blood cells) are destroyed), thrombocytopenia (abnormal reduction in platelets/platelets), and acute kidney injury (AKI); Mostly occurring in children in the context of infections; most common cause of acute renal failure requiring dialysis in childhood.
  • Infections with various pathogens such as pneumococci or staphylococci.
  • Cold antibody autoimmune hemolytic anemia, often due to lymphoma (malignant disease of lymphoid tissue) or infections
  • Liver cirrhosis – connective tissue remodeling of the liver with functional impairment.
  • Malaria – tropical infectious disease transmitted by the Anopheles mosquito.
  • Malignant hypertension – severe hypertension with diastolic values above 120 mmHg, which quickly leads to kidney damage.
  • Metastatic carcinoma – cancers that have “spread” daughter tumors.
  • Morbus haemolyticus neonatorum – complication in pregnancy that occurs when there is incompatibility of blood types between mother and child.
  • Paroxysmal cold hemoglobinuria – disease that often occurs in the context of viral infections, in syphilis or as an autoimmune disease.
  • Paroxysmal nocturnal hemoglobinuria (PNH) – acquired disease of the hematopoietic stem cell caused by a mutation of the phosphatidyl inositol glycan (PIG) A gene; characterized by hemolytic anemia (anemia caused by the breakdown of red blood cells), thrombophilia (tendency to thrombosis), and pancytopenia, ie. i.e. a deficiency in all three cell series (tricytopenia) of hematopoiesis, i.e. a leukocytopenia (reduction of white blood cells), anemia and thrombocytopenia (reduction of platelets), is characterized.
  • Splenomegaly (enlargement of the spleen) caused by heart failure or inflammation
  • Thrombotic thrombocytopenic purpura (TTP; synonym: Moschcowitz syndrome) – acute onset of purpura with fever, renal insufficiency (kidney weakness; renal failure), anemia (anemia), and transient neurologic and mental disorders; occurrence largely sporadic, autosomal dominant in the familial form
  • Heat antibody autoimmune hemolytic anemia, often due to lymphoma (malignant disease of lymphoid tissue) or viral infections.
  • Burns
  • Zieve syndrome – characterized by a triad of: Hyperlipoproteinemia (also hyperlipidemia; fat metabolism disorder), hemolytic anemia (anemia due to destruction of red blood cells) alcohol toxic liver damage with icterus (jaundice).

Medication

Anemia

Aplastic anemia

Note: For drugs marked with an asterisk (* ), the association with aplastic anemia is poorly documented. Environmental exposure – intoxications (poisonings).

  • Copper
  • Snake venom
  • Spider Venoms

Other causes

  • Blood transfusions
  • Artificial heart valve replacement and other vascular endoprostheses.
  • Methylene blue (dye)