Hemolytic Anemia

What is hemolytic anemia? 

Hemolytic anemia is a condition in which red blood cells are destroyed. That means they are removed from the bloodstream sooner than they should be. The destruction of these red blood cells causes anemia (low red blood cell levels).  

A red blood cell normally lives for about 120 days (about 4 months. In children with hemolytic anemia, the red blood cells live for only 30 days (about 4 and a half weeks) or less.  

The breakdown of red blood cells is called hemolysis. 

How hemolytic anemia develops 

Most hemolytic anemias are inherited. This means the disease is passed down from parent to child. But your child could also be the first person in the family to have this problem.  

It is possible that your child might pass it on to their children. 

Diagnosing hemolytic anemia 

Your child’s care team may order a complete blood cell test (CBC) or genetic tests to diagnose hemolytic anemia.  

Types of hemolytic anemia 

• Membrane disorders (such as spherocytosis, elliptocytosis) – The red blood cells have an abnormal cell membrane. This causes them to be different shapes. They are easily destroyed or damaged.  
• Enzyme deficiencies (such as pyruvate kinase deficiency) – The red blood cells are missing an enzyme that helps them live. Without the enzyme, the red blood cells break down.  
• Hemoglobin diseases (such as sickle cell anemia, thalassemia, hemoglobin C disease) – Normally, hemoglobin carries oxygen to all body parts. In these disorders, hemoglobin is not made normally. The red blood cells in these disorders may only live for 10–20 days (about 3 weeks). This leads to low red blood cell counts.  
• Autoimmune hemolytic anemia (AIHA) – This type of anemia does not have a known cause.    

Symptoms of hemolytic anemia 

Anemia  

This means the red blood cell count is lower than normal. If your child develops an infection such as a cold or virus, anemia can get worse. Your child may need to see the doctor. In rare cases, your child might need a blood transfusion.  

Jaundice  

When the red blood cells break down, some of the cell contents are changed into bilirubin. An increase in bilirubin causes jaundice (yellowing of the skin or eyes). Jaundice may appear to get worse when your child is sick. 

Enlarged spleen  

The spleen is an organ on the left side of the body under the ribcage. It is about the size of a fist. It helps the body:  

• Fight infection  
• Create and filter blood cells  

Abnormal blood cells can get trapped in the spleen. They break down. This causes the spleen to grow. If needed, the spleen can be removed by surgery (splenectomy). Removing the spleen can improve the red blood cell count.  

Before surgery to remove your child’s spleen, your child’s care team may want to ensure they are up to date on their needed vaccines. 

Gallstones 

Gallstones are made of bilirubin. Some children develop them. They might need their gallbladder removed by surgery if the stones cause stomach pain or other symptoms.  

Treatment for hemolytic anemia 

No medicine can make the red blood cells become normal again. Most children will do fine without any treatment. But some need blood transfusions or a splenectomy. 

When to call your child’s care team

Reach out if your child: 

• Looks pale 
• Has increased jaundice 
• Is more tired than usual 

Your child may need a blood count test to check red blood cell levels.  

Call your child’s care team if you have questions or concerns. They are available to help you.