Hemolytic anemia is a form of anemia where red blood cells are destroyed faster than they can be replaced. This may happen either intravascularly or extravascularly.
The patient presents with anemia and jaundice. Diagnosis is based on several laboratory parameters 1:
- suggested by a raised mean cell volume (MCV)
- a blood film can confirm
- increased unconjugated bilirubin
- increased lactate dehydrogenase
- decreased haptoglobin
With the excessive red cell destruction, there is compensatory erythroid hyperplasia in the bone marrow, resulting in increased production of erythroid precursors (reticulocytosis).
Hemolytic anemia can be due to defects in:
- red blood cell membrane production
- hemoglobin production
- autoimmune diseases
- portal hypertension (resulting in hypersplenism)
- paroxysmal nocturnal hemoglobinuria (PNH)
- drug-induced 2
- lead poisoning
- secondary to malignancy 1
- prosthetic heart valves: primarily due to mechanical trauma of the RBCs 4
Chronic hemolytic anemia may present on imaging as marrow reconversion and/or splenomegaly. Some underlying causes of hemolytic anemia (e.g. sickle cell disease) have more specific imaging findings: see the relevant articles for more details.
- 1. Dhaliwal G, Cornett PA, Tierney LM. Hemolytic anemia. Am Fam Physician. 2004;69 (11): 2599-606. Pubmed citation
- 2. Petz LD, Garratty G. Drug-induced haemolytic anemia. Clin Haematol. 1976;4 (1): 181-97. Pubmed citation
- 3. Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am. J. Hematol. 2002;69 (4): 258-71. Pubmed citation
- 4. Maraj R, Jacobs LE, Ioli A, Kotler MN. Evaluation of hemolysis in patients with prosthetic heart valves. (1998) Clinical cardiology. 21 (6): 387-92. Pubmed