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Hemolytic crisis

Definition

Hemolytic crisis occurs from the rapid destruction of large numbers of red blood cells (hemolysis). The destruction occurs much faster than the body can produce new red blood cells.

Alternative Names

Hemolysis - acute

Considerations

A hemolytic crisis causes acute (and often severe) anemia, because the body cannot make enough red blood cells to replace those that are destroyed. The part of red blood cells that carries oxygen (hemoglobin) is released into the bloodstream, which can lead to kidney damage.

Causes

There are many causes of hemolysis, including:

  • A lack of certain enzymes inside red blood cells
  • Autoimmune diseases
  • Certain infections
  • Defects in the hemoglobin molecules inside red blood cells
  • Defects of the proteins that make up the internal framework of red blood cells
  • Medication side effects
  • Reactions to blood transfusions

Many of these conditions can lead to a hemolytic crisis.

When to Contact a Medical Professional

If you have any of the following symptoms, contact your doctor:

  • A decrease in the amount of urine you produce
  • Fatigue, pale skin, or other symptoms of anemia, especially if these symptoms get worse
  • Urine that looks red, red-brown, or brown (tea-colored)

What to Expect at Your Office Visit

Emergency treatment may be necessary. This may include a hospital stay, oxygen, blood transfusions, and other treatments.

When your condition is stable, your doctor will perform a physical examination and ask questions, such as:

  • When did you first notice symptoms?
  • What symptoms did you notice?
  • Do you have a history of hemolytic anemia, G6PD deficiency, or a kidney disorder?
  • Does anyone in your family have a history of hemolytic anemia or abnormal hemoglobin proteins?

The physical examination may occasionally show swelling of the spleen (splenomegaly).

Tests may include:

References

Schwartz RS. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 164.

Golan DE. Hemolytic anemias: red cell membranes and metabolic defects. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 165.

Gregg XT, Prchal JT. Red blood cell enzymopathies. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 45.

Gallagher PG, Jarolim P. Red blood cell membrane disorders. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 46.

Powers A, Silberstein LE. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 47.

Schrier SL, Price EA. Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 48.

Review Date: 1/31/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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