Hemolysis: types, causes and treatments


Hemolysis refers to the destruction of red blood cells (RBCs). Typically, RBCs can live up to 120 days before the body naturally destroys them. However, certain conditions and medications can cause them to break down faster than usual.

RBCs or erythrocytes are one of the main components of blood. They are shaped like a slightly indented, flattened disk and help transport oxygen to and from the lungs. The average life span of a healthy erythrocyte is about 4 months.

Typically, the body destroys old or damaged red blood cells in the spleen or other parts of the body through a process known as hemolysis.

Normally, the body is able to quickly replace and approximately produce erythrocytes 2 million blood cells every second. However, symptoms of anemia may appear when the body has a low number of erythrocytes due to excessive hemolysis.

In this article, we discuss hemolysis in detail, including its possible causes and treatment options.

Hemolysis is the mental breakdown by RBC’s. Some people refer to hemolysis by other names, such as hematolysis, erythrolysis, or erythrocytolysis.

Hemolysis is a natural bodily process that occurs when erythrocytes get too old. As we age, red blood cells lose certain properties and work less efficiently. For example, they can lose their malleability, allowing them to reversibly change shape to pass through blood vessels.

As RBCs begin to lose their functionality, they accumulate signals that trigger erythrocyte turnover. The body typical performs hemolysis in the spleen. As blood filters through this organ, it can detect old or damaged erythrocytes. Then large white blood cells or macrophages break down these red blood cells.

However, some conditions, drugs, and toxins can cause red blood cells to break down faster than usual.

A doctor can measure a person’s hematocrit. This refers to the percentage of red blood cells in the body. A typical hematocrit reading can vary depending on many factors such as age and race. However, low concentrations may indicate a high turnover of erythrocytes.

There are many potential factors that can lead to hemolysis. The cause of hemolysis can be extrinsic, coming from an external source, or intrinsic, coming from the red blood cells themselves.


Extrinsic causes include specific conditions or external factors that destroy RBC, such as:

  • chemicals
  • infections
  • Drugs such as penicillin, paracetamol, quinidine, rifampin, heparin and clopidogrel
  • any condition that causes increased spleen activity
  • Immune reactions such as autoimmune hemolytic anemia (AIHA) and incompatible blood transfusions
  • intense physical activity
  • mechanical damage from artificial heart valves, hemodialysis, and cardiopulmonary bypass machines
  • Toxins such as lead and copper
  • Poisons, including poisons


Certain conditions can lead to changes within the erythrocytes themselves, which can lead to hemolysis. These can be malformations in the cell structure and in the metabolism or in the hemoglobin structure.

These terms may include:

  • hereditary cell membrane disorders such as hereditary spherocytosis
  • acquired cell membrane disorders, including paroxysmal nocturnal hemoglobinuria
  • Diseases affecting erythrocyte metabolism, such as B. Glucose-6-phosphate dehydrogenase deficiency
  • Hemoglobinopathies such as thalassemia and sickle cell anemia
  • Abnormalities in the erythrocyte membrane, such as elliptocytosis

Excessive hemolysis can lead to hemolytic anemia. This refers to a group of conditions that have symptoms similar to other types of anemia because hemolysis occurs too quickly or too often.

The condition can develop suddenly or slowly and can be mild or severe. Possible symptoms might include:

Symptoms of severe hemolytic anemia can include:

Hemolytic disease of the newborn, also known by health professionals as erythroblastosis fetalis, is a blood disorder in which Rhesus (Rh) factor incompatibility occurs during pregnancy. This refers to a protein that can be present on the surface of RBCs.

If a person with Rh-negative blood becomes pregnant and the fetus inherits Rh-positive blood from the person’s partner, a harmful immune response can result. Around 1-3 out of 1,000 people experience this reaction.

During pregnancy, blood from the fetus can cross the placenta and enter the blood of the parents. In the case of Rh incompatibility, the parents’ immune system may recognize this blood as foreign material and produce antibodies against the Rh-positive blood.

This is more likely to happen after the first pregnancy, as the pregnant woman’s immune system recognizes the fetal blood as foreign and has antibodies ready. If doctors catch this early, they can prevent this condition by giving the parent a Rh immunoglobulin (RHIg) to prevent their immune system from making antibodies.

A person is given RHIg as an injection at 28 weeks of pregnancy to prevent the production of antibodies and within 72 hours after the birth of the baby with Rh positive blood to prevent the production of antibodies that could affect a future pregnancy .

AIHA is a rare condition in children that affects 0.8 out of 100,000 Children under the age of 18. It can occur after a recent viral infection or after taking certain medications. It can also be due to some conditions.

The most common form of AIHA in children is due to heat-reactive antibodies. The term “warm-reactive” refers to the fact that optimal antigen binding occurs near body temperature at 98.6°F.

A Study 2021 notes that sudden presentation of AIHA is often life-threatening and rapidly progressive, requiring prompt diagnosis, treatment, and monitoring.

First, a doctor reviews a person’s symptoms and medical history and performs a physical exam.

If they suspect hemolytic anemia, they will may request the following tests:

  • Complete blood count: This can help determine the number of red blood cells and their size, as well as a person’s hematocrit.
  • Peripheral blood smear: This test checks the size and shape of the red blood cells and identifies any abnormalities.
  • Reticulocyte Count: Doctors use this test to check the bone marrow’s ability to compensate for the premature destruction of red blood cells.
  • serum bilirubin: This yellow pigment is an end product of the breakdown of RBCs. High serum bilirubin levels may indicate hemolytic anemia.
  • Milk dehydrogenase (LDH): A high serum LDH may indicate that the erythrocytes are undergoing hemolysis.
  • Serum haptoglobin: This protein binds to hemoglobin when the erythrocytes die. When there is too much hemoglobin in circulation due to hemolysis, haptoglobin levels drop.
  • Coombs test: This test helps to recognize the presence of antibodies capable of inducing hemolysis.
  • genetic testing: These exams can help with identification Hemoglobinopathies such as sickle cell anemia and thalassemia.

Treatment options depend on the cause of the hemolysis. In addition, when creating a treatment plan, doctors consider the following:

  • the age and general health of the person
  • their ability to administer and manage treatments
  • severity of the disease

Treatments can include:

  • blood transfusion: This can help replace RBCs immediately. It also rapidly increases a person’s blood cell count.
  • folic acid: A doctor may suggest this supplement since hemolysis depletes folic acid.
  • corticosteroids: These drugs can reduce the activity of the immune system to prevent the body from destroying its own red blood cells.
  • Intravenous immunoglobulin (IVIg): A person with certain types of hemolytic anemia can receive IVIg injections to boost their immune system. These are injections into a vein and directly into the bloodstream.
  • Rituximab: That is a First line treatment for steroid fireproof warm AIHA. A healthcare professional can also use it as a first and second line treatment for cold agglutinin disease.
  • Surgery: In some severe cases, a doctor may suggest removing a person’s spleen through surgery.
  • Hematopoietic stem cell transplantation: In some cases, treatment may include a bone marrow transplant to allow a person’s body to produce enough red blood cells.

The byproducts of RBC destruction can produce reactions that can damage multiple organs. Complications from hemolytic anemia may include:

Arrhythmia, cardiomyopathy, heart failure and iron deficiency are other possible complications.

It is advisable to consult a doctor if any of the following symptoms appear:

Hemolysis is a natural process by which the body destroys older red cells that are no longer working efficiently. However, some conditions, medications, and toxins can cause RBCs to break down prematurely.

When this happens, symptoms of anemia such as fatigue, dizziness, and headaches may appear. In other cases, the symptoms can be more severe.

A person showing early signs of anemia should see a doctor for prompt diagnosis and treatment.


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