Pediatric Anemia (hemolytic)

Hemolytic anemia is a group of disorders in which the red blood cells are destroyed faster than the bone marrow can make them. The term for destruction of red blood cells is hemolysis.

Hemolytic anemia has 2 types of causes:

• Intrinsic. This is when the destruction of red blood cells is due to a flaw within the red blood cells. This type is often inherited. It includes sickle cell anemia, thalassemia or erythrocytosis. These conditions produce red blood cells that don't live as long as normal red blood cells.
• Extrinsic. This is when the destruction of red blood cells is from a cause outside of the cells. This is also called autoimmune hemolytic anemia. Some of the causes are:
  • Infections from bacteria or viruses
  • Medicines such as antibiotics like penicillin or sulfonamides, medicines for malaria or acetaminophen
  • Cancers such as leukemia, lymphoma or other tumors
  • Autoimmune disorders such as systemic lupus erythematous (SLE or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
  • Hypersplenism, a condition in which the spleen destroys more red blood cells than normal

Some types of extrinsic hemolytic anemia are temporary and go away over several months. Other types can become chronic with periods of remissions and recurrence.

Call your child's healthcare provider if your child's behavior changes. For example, your child may not be able to be as active as usual. Also call your child's provider if your child has yellowing of the skin, dark urine or a fever.

Your child’s healthcare provider may suspect hemolytic anemia from your child's medical history and a physical exam. Your child may have these tests:

• Hemoglobin and hematocrit. This test measures the amount of hemoglobin and red blood cells in the blood.
• Complete blood count (CBC). This test checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral smear. A small sample of blood is viewed under a microscope. Blood cells are checked to see if they look normal or not.
• Other blood tests. These tests will check for lactate dehydrogenase, bilirubin and haptoglobin which can causes ongoing hemolysis. Certain tests can find antibodies that cause hemolysis.
• Urine tests. These tests can check for hemoglobin from red blood cells breaking down.
• Bone marrow aspiration, biopsy or both. A small amount of bone marrow fluid (aspiration), solid bone marrow tissue (called a core biopsy) often from the hip bones, or both are checked for the number, size and maturity of blood cells. This test may also look for abnormal cells.

These are the most common symptoms of hemolytic anemia:

• Pale skin
• Jaundice or yellowing of the skin and eyes
• Dark-colored urine
• Fever
• Weakness
• Dizziness
• Confusion
• Intolerance to physical activity
• Enlargement of the spleen and liver
• Fast heart beat
• Heart murmur

The symptoms of hemolytic anemia may look like other health problems. Always check with your child's doctor for a diagnosis.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

A child with hemolytic anemia is often treated by a hematologist. This is an expert in blood disorders. The treatment for hemolytic anemia will vary depending on the cause of the illness and how severe the anemia is. Some children do not need treatment. For those that do, treatment may include:

• Blood transfusions
• Corticosteroid or steroid medicines
• Intravenous immune globulin (IVIg)
• Rituximab, a medicine to control the immune system
• Antibiotics to treat the infection if that is the underlying cause
• Other medicines, depending on the type of hemolytic anemia

In some children, who don't respond to other therapy, these treatments may be needed:

• Splenectomy. This is surgery to remove the spleen.
• Immunosuppressive therapy. This is the use of other medicines to control the immune system.
• Plasmapheresis. This is the removal of antibodies from the blood that are destroying red blood cells.
• Stem cell transplant. In severe cases, abnormal bone marrow cells are replaced with donor bone marrow.

Complications depend on the cause of the hemolytic anemia and include:

• Side effects of medicines. For example, the increased risk of infection with corticosteroids.
• Gallstones or stones in the gallbladder
• Blood clots and blood clots in the lungs (pulmonary emboli)
• Kidney failure
• Shock
• Heart failure

Managing hemolytic anemia depends on how severe the symptoms are. Children with mild symptoms will have regular blood checks.

Managing children with more severe symptoms is more complex. These children will also have their blood checked regularly. They may have trouble with daily activities due to their symptoms or treatment. If your child is taking medicine that increases the risk of infection, he or she should stay away from people who are sick.