Haemolytic anaemia

Haemolytic anaemia is a condition where red blood cells are destroyed faster than the body can replace them, leading to a shortage of healthy red blood cells and symptoms of anaemia. It can be caused by problems within the red blood cells themselves, or by external factors attacking otherwise normal cells. It ranges from mild and chronic to severe and rapidly developing.

Causes include inherited conditions such as hereditary spherocytosis or G6PD deficiency, autoimmune conditions where the immune system attacks red blood cells, certain infections, some medications, and mechanical causes such as faulty heart valves. Identifying the specific cause is important because it guides treatment. Sometimes several contributing factors are present at once.

Symptoms include fatigue, pale skin, shortness of breath, a rapid heartbeat, and sometimes yellowing of the skin and eyes (jaundice) due to breakdown products of red blood cells. Dark urine can also occur in some forms. Severe or rapid haemolysis can cause more acute symptoms needing urgent assessment.

Severity varies widely: some forms are mild and well tolerated, while others, particularly rapid or severe haemolysis, can be serious and require urgent treatment, including blood transfusion. Long-standing haemolysis can also lead to complications such as gallstones. With appropriate diagnosis and treatment of the underlying cause, most people can be managed effectively.

Some forms are inherited, such as hereditary spherocytosis, sickle cell disease, and G6PD deficiency, while others, like autoimmune haemolytic anaemia, are acquired rather than genetic. Blood tests, sometimes including genetic testing, help determine whether an inherited cause is present. This distinction matters for both treatment choice and any implications for family members.

Treatment depends on the underlying cause: autoimmune haemolytic anaemia is often treated with steroids or other immune-suppressing medication, while inherited forms may be managed with supportive care, folic acid supplementation, or occasionally removal of the spleen. Blood transfusion may be needed for severe or rapidly developing anaemia. A haematologist tailors treatment to the specific type and severity.

Some acquired causes, such as certain drug-induced or infection-related haemolytic anaemia, resolve once the trigger is removed or treated. Inherited forms are generally lifelong but can often be well managed with appropriate monitoring and treatment, allowing a good quality of life. Autoimmune forms can sometimes go into long remission with treatment, though relapse is possible.

Haemolytic anaemia is caused by red blood cells being destroyed faster than normal, whereas iron deficiency anaemia results from inadequate iron for making new red blood cells, usually due to blood loss or poor absorption or intake. Blood tests can distinguish the two, since haemolysis typically shows specific markers like raised bilirubin and reduced haptoglobin, which are not seen in iron deficiency. Treatment is very different between the two, so accurate diagnosis is important.

See a doctor if you have unexplained fatigue, pale skin, or yellowing of the eyes or skin, so blood tests can be arranged to check for anaemia and its cause. A private haematology assessment can typically be arranged within about one to two weeks. Seek urgent care for severe symptoms such as significant breathlessness, chest pain, or a rapid heartbeat, as these can indicate more severe anaemia needing prompt treatment.