• symptoms and signs

• laboratory findings

• about the disease

• prevention

• treatment

• prognosis

Symptoms & signs.  hemolysis can be acute or chronic; symptoms of chronic hemolysis include fatigue, weakness, dyspnea, and pallor; individuals with chronic symptoms may suffer from a physiologic or emotional stressor that triggers a hemolytic crisis;  acute hemolytic crisis (rare) is characterized by chills, fever; headache,  pain in the back, abdomen, and joints; organ enlargement (spleen and liver); lymphadenopathy; and reduced urinary output

Laboratory findings.  decreased Hgb and hematocrit on CBC; serum tests may reveal elevated lactate dehydrogenase and bilirubin; hyperplasia on bone marrow aspiration; elevated reticulocyte count; elevated urine/fecal urobilinogen decreased Hgb and hematocrit on CBC; serum tests may reveal elevated lactate dehydrogenase and bilirubin; hyperplasia on bone marrow aspiration; elevated reticulocyte count; elevated urine/fecal urobilinogen

About the disease.  In hemolytic anemia, there is abnormal or premature destruction of red blood cells and the inability of the bone marrow to produce sufficient RBCs to compensate.  The etiology is typically related to an extracorpuscular factor (e.g.,  trauma, burns, surgery, chemical agents, drugs, infectious organisms, systemic diseases). Less common are intracorpuscular causes, such as a glucose-6-phosphate dehydrogenase (G6PD) deficiency. The precipitating factor results in a shortened life span for erythrocytes and an increase in erythrocyte destruction by the reticuloendothelial system. The bone marrow is unable to produce sufficient replacement cells to keep pace with the destruction, and anemia ensues.

Prevention.  identification and removal of causative agent

Treatment.  elimination of etiologic agent; erythrocytopheresis (RBC exchange); transfusion; oxygen therapy for hypoxemia; fluid and electrolyte management; corticosteroids to depress extracorpuscular factors and diminish inflammatory response; diuretics to prevent tubular necrosis; folic acid to increase RBC production; surgical removal of the spleen

Prognosis.  chronic symptoms can lead to jaundice, arthritis, renal failure, and other organ failure; crisis can lead to paresthesia, paralysis, chills, vomiting, shock, and organ failure