Do you sometimes just feel tired and dizzy? Or do you sometimes feel like your skin is a little yellow, and the whites of your eyes are yellow? This could be something to do with your red blood cells, one of the most important types of cells in your blood. Today we're going to talk about a condition called hemolysis , which is when red blood cells break down and are destroyed prematurely. Don't worry, it's important to be aware of this.
What exactly is hemolysis?
Simply put, hemolysis is the destruction of red blood cells in our body . You know, these red blood cells are like little workers in our blood. They are the ones who take oxygen from the lungs when we breathe and deliver it to every other cell and tissue in the body. It's like bringing a gas cylinder home. So, our body uses this oxygen to produce the energy it needs. Also, these same red blood cells help carry the unwanted carbon dioxide that builds up in our body back to the lungs and exhale it.
Normally, our bodies continuously destroy old or weak red blood cells and replace them with new, healthy red blood cells. This is like getting rid of old ones and getting new ones. This cycle of destruction and production is why we always have the right amount of red blood cells in our bodies.
However, sometimes these red blood cells start to break down prematurely, that is, too quickly . This can happen before our body has time to make new cells to fill the gap. This rapid destruction of red blood cells is called hemolysis. If the number of red blood cells in the body decreases significantly due to this hemolysis, we call that condition hemolytic anemia , or anemia.
Why are red blood cells destroyed in this way?
A red blood cell usually lives for about 120 days. At the end of this period, when those cells become old, they release special signals. These signals cause the spleen (located on the left side of the abdomen) in our body to destroy these old cells in an orderly manner. Just like we get rid of old, broken furniture in our house.
New red blood cells are made in a spongy part of our bones called bone marrow . The new red blood cells made in this bone marrow are then released into the blood.
However, sometimes a defect in the shape or composition of a red blood cell can shorten its lifespan. Or, red blood cells can be damaged by external factors and die before the body can make new cells.
What are the main types of hemolysis?
Hemolysis can be divided into two main types. These names refer to where the red blood cells are destroyed.
1. Extravascular hemolysis: This is when red blood cells are destroyed outside of our blood vessels (i.e., the veins, arteries, and capillaries). Most often, this happens in the spleen . As blood passes through the spleen, a special type of white blood cell called macrophages (these are like our body's security guards) recognize old, damaged red blood cells and destroy them.
2. Intravascular hemolysis: In this, red blood cells are destroyed inside the blood vessels. When they are destroyed, pieces of those cells travel throughout the body with our blood.
What are the causes of hemolysis?
There is not just one cause of hemolysis, but a number of factors that can contribute to it. Let's look at it in a little more detail.
1. Defects in the red blood cells themselves
Sometimes, if there is an abnormality or defect in the shape or structure of a red blood cell, that cell can be destroyed quickly. Such defects are often caused by certain congenital, or hereditary, diseases .
- Hemoglobin instability: Hemoglobin is a protein that helps carry oxygen inside red blood cells. Conditions that cause this instability include sickle cell anemia (where red blood cells become sickle-shaped) and thalassemia .
- Enzyme deficiencies: This condition can also occur when certain enzymes needed for the function of red blood cells are lacking. Examples include G6PD deficiency and pyruvate kinase deficiency .
- Membrane defects: Conditions in which there are defects in the outer covering of red blood cells, the cell membrane. Examples include hereditary spherocytosis ( cells become spherical) and hereditary elliptocytosis (cells become elongated).
2. Diseases related to the immune system
Sometimes our own immune system (the system that protects us from disease) mistakenly starts attacking our own red blood cells. This is called autoimmune hemolytic anemia (AIHA) . This is a rare condition. There are also types of this:
- Cold agglutinin disease ( symptoms worsen when exposed to cold)
- Warm agglutinin disease
Some other underlying conditions that can cause AIHA include Mycoplasma pneumonia , lymphoma , leukemia (these are types of cancer), lupus, and rheumatoid arthritis (these are also autoimmune diseases).
Other non-autoimmune conditions:
- Paroxysmal cold hemoglobinuria
- Paroxysmal nocturnal hemoglobinuria
3. Infections
Some parasites, viruses, and bacteria that enter our bodies can damage our red blood cells, destroying them before they can be replaced. A good example of this is malaria . The parasite that causes malaria directly attacks red blood cells.
Other causes of infection:
- Babesiosis
- Carrion's disease
- Rocky Mountain spotted fever
- Haemophilus influenza
- Human immunodeficiency virus (HIV)
4. Some medications
Some medications we take can also, although very rarely, stimulate our immune system to attack red blood cells and destroy them quickly. This is called drug-induced immune hemolytic anemia (DIHA) . This is very rare.
Some drugs that can cause hemolysis:
- Acetaminophen ( paracetamol)
- Some cephalosporin antibiotics
- Clopidogrel
- Dapsone
- Heparin
- Levodopa
- Levofloxacin
- Methyldopa
- Nitrofurantoin
- Penicillin
- Phenazopyridine
- Quinidine
- Quinine
- Rifampin
- Some sulfonamides
Important: Don't be alarmed by this list of medications. These medications rarely cause hemolysis. If a doctor has prescribed these medications for you, follow their instructions. If you have any questions, talk to your doctor.
5. Complications during pregnancy
Some complications during pregnancy can also cause red blood cells to break down quickly.
- HELLP syndrome
- Preeclampsia
- Eclampsia
Because these are serious conditions that can occur during pregnancy, it is essential to seek medical advice immediately if symptoms appear.
6. Medical equipment and treatments
This is also rare. Hemolysis can occur when certain medical devices are implanted in the body, or during certain treatments, until the body adjusts to them.
- Hemodialysis for kidney patients
- Heart-lung bypass machine (used in major surgeries)
- Heart valve replacements
- Other devices used in conditions such as heart failure, for example intra-aortic balloon pumps and Impella devices .
- Blood transfusions (such as when incompatible blood is given)
7. Poisons and toxins
Some toxins, when ingested, can damage red blood cells and cause hemolysis.
- Arsenic
- Copper ( if ingested in excess)
- Lead
- Arsine ( poisonous gas)
- Stibine ( poisonous gas)
- Snake venom
Additionally, any condition in which the spleen is overactive (hypersplenism) can also cause hemolysis. Similarly, extremely elevated blood pressure can cause red blood cells to rupture as blood moves through the blood vessels too quickly.
What are the symptoms of hemolysis?
Symptoms depend on how low your red blood cell count is. If your red blood cell count is not too low, you may not experience any symptoms. Most of the time, symptoms occur because the body's cells and tissues are not getting enough oxygen because of the low red blood cell count.
Common symptoms:
- Fatigue
- Dizziness
- Pale skin
- Heart palpitations / tachycardia
- Shortness of breath / dyspnea
- Yellowing of the skin and whites of the eyes (Jaundice) (This is caused by the accumulation of bilirubin, a substance released when red blood cells break down, in the blood)
- Enlarged spleen / splenomegaly
Some symptoms may vary depending on the specific condition causing the hemolysis. For example, someone with cold agglutinin disease may experience decreased blood flow to the fingertips and toes, causing them to turn blue and become numb (Raynaud's phenomenon) .
What tests are done to determine if there are problems related to hemolysis?
A doctor will take a sample of your blood and run several tests to see if your low red blood cells are due to hemolysis.
- Complete blood count (CBC): This can tell you a lot about all the types of cells in your blood, especially your red blood cells. It can check things like your hemoglobin level and how much space your red blood cells take up in your blood (hematocrit).
- Reticulocyte count: This is part of the CBC test. Reticulocytes are newly formed red blood cells that have not yet fully matured. When there is hemolysis, the reticulocyte count may increase as the body speeds up the production of new cells to replace those that are destroyed.
- Peripheral blood smear: This test can check for abnormalities in the shape and size of your blood cells. Abnormally shaped cells are more likely to be destroyed quickly.
- Lactate dehydrogenase (LDH): LDH is an enzyme found inside red blood cells. When red blood cells are broken down faster than normal, LDH levels in the blood can increase.
- Haptoglobin test: Haptoglobin is a protein that is associated with hemoglobin. When red blood cells are broken down (as in hemolysis), large amounts of hemoglobin are released into the blood. Haptoglobin levels then decrease.
- Unconjugated bilirubin: Bilirubin is produced when hemoglobin in red blood cells breaks down. High levels of bilirubin in the blood indicate that a large number of red blood cells are being destroyed (this is what causes jaundice).
- Direct Coombs test: This test can detect whether you have antibodies that attach to your red blood cells and quickly destroy them (this can help diagnose conditions like AIHA).
Additionally, a doctor may perform a urinalysis to check for blood and bilirubin in your urine, which can be signs of a condition called hemolytic anemia.
How is hemolysis treated?
Your treatment will depend on the cause of your hemolysis and how severe your symptoms are. Treatment options may include vitamins, medications, surgery, and blood transfusions.
The most important thing is to talk to your doctor about the treatment that is best for you, based on your diagnosis.
Our bodies are constantly trying to maintain the right number of red blood cells. However, infections, congenital diseases, and external influences can disrupt this process and cause red blood cells to be destroyed too quickly. As a result, a decrease in red blood cells can occur, leading to hemolytic anemia.
However, the good news is that many of the causes of hemolysis can be treated. Once a doctor has determined the cause of your hemolysis, they will prescribe treatments to help bring your red blood cell count back to normal.
Important things to remember (Take-Home Message)
- Hemolysis is the premature destruction of red blood cells.
- This can cause symptoms such as extreme fatigue, dizziness, and yellowing of the skin (jaundice) .
- There can be many causes; defects in the red blood cells themselves, immune system problems, infections, certain medications, complications during pregnancy, and more.
- If you have these symptoms, definitely seek medical advice .
- Blood tests can help determine the cause and provide appropriate treatment.
- Many causes can be treated to restore red blood cell levels. So it's important not to panic and seek proper medical guidance.
I hope you find this information useful. Stay healthy!
` Hemolysis, red blood cells, anemia, spleen, bone marrow, jaundice, blood tests
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