Hemolytic anemia causes: Difference between revisions
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{{Hemolytic anemia}} | {{Hemolytic anemia}} | ||
{{CMG}} | {{CMG}}; {{shyam}} | ||
==Overview== | ==Overview== | ||
The causes for hemolytic anemia can be divided into intracorpuscular or extracorpuscular causes. The intrinsic causes are commonly due to hereditary causes whereas the extrinsic causes are | The causes for hemolytic anemia can be divided into intracorpuscular or extracorpuscular causes. The intrinsic causes are commonly due to [[hereditary]] causes whereas the extrinsic causes are commonly acquired. [[Drugs]] are another major cause of [[hemolysis]]. In the era of [[immunotherapy]] for [[cancer]], drug-related causes are becoming increasingly important to recognize. | ||
==Causes== | ==Causes== | ||
The causes of hemolytic anemia can be divided into etiologies that are intrinsic to red blood cell biology or extrinsic to red blood cell biology. Intrinsic, or intracorpuscular, causes include red blood cell membrane defects or enzyme deficiencies. Extrinsic causes include infections, autoimmune conditions, or drugs. | The causes of hemolytic anemia can be divided into etiologies that are intrinsic to [[red blood cell]] biology or extrinsic to [[red blood cell]] biology. Intrinsic, or intracorpuscular, causes include [[red blood cell]] membrane defects or enzyme deficiencies. Extrinsic causes include [[infections]], [[autoimmune]] conditions, or [[drugs]]. | ||
===Intrinsic or Intracorpuscular Factors=== | ===Intrinsic or Intracorpuscular Factors=== | ||
====Red blood cell membrane defects==== | ====Red blood cell membrane defects==== | ||
*[[Paroxysmal nocturnal hemoglobinuria]] | *[[Paroxysmal nocturnal hemoglobinuria]] | ||
*[[Alpha thalassemia]] | *[[Alpha thalassemia]] | ||
*[[Hereditary spherocytosis]] | *[[Hereditary spherocytosis]]: This is the most common hereditary form of hemolytic anemia.<ref name="pmid24466544">{{cite journal| author=Jung HL| title=A new paradigm in the diagnosis of hereditary hemolytic anemia. | journal=Blood Res | year= 2013 | volume= 48 | issue= 4 | pages= 237-9 | pmid=24466544 | doi=10.5045/br.2013.48.4.237 | pmc=3894378 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24466544 }} </ref> It is caused by [[mutations]] in [[red blood cell]] [[cytoskeletal]] [[proteins]], such as: | ||
**[[Spectrin]] | |||
**[[Ankyrin]] | |||
**[[Band 3]] | |||
**[[Band 4.1]] | |||
**[[Glycophorin]] | |||
*[[Hereditary elliptocytosis]] | *[[Hereditary elliptocytosis]] | ||
*Unstable [[hemoglobin]] variants and [[hemoglobinopathies]] | *Unstable [[hemoglobin]] variants and [[hemoglobinopathies]] | ||
Line 21: | Line 27: | ||
*[[Glucose-6-phosphate dehydrogenase deficiency]] | *[[Glucose-6-phosphate dehydrogenase deficiency]] | ||
*[[Pyruvate kinase deficiency]] | *[[Pyruvate kinase deficiency]] | ||
*[[Triose phosphate isomerase deficiency]] | *[[Triosephosphate isomerase|Triose phosphate isomerase]] [[deficiency]] | ||
===Extrinsic Factors=== | ===Extrinsic Factors=== | ||
Extrinsic factors refers to those that are commonly acquired in nature and have an adverse effect on red blood cells. | Extrinsic factors refers to those that are commonly acquired in nature and have an adverse effect on [[Red blood cell|red blood cells]]. | ||
====Infections==== | ====Infections==== | ||
* | *Shiga-toxin from [[EHEC|enterohemorrhagic E. coli]] strain O157:H& | ||
*[[Parvovirus]] | *[[Parvovirus]] | ||
*[[Malaria]] | *[[Malaria]] | ||
*[[Babesia]] | *[[Babesia]] | ||
*[[ | *[[Clostridium perfringens]] | ||
====Autoimmune or rheumatologic conditions==== | ====Autoimmune or rheumatologic conditions==== | ||
Systemic activation of the immune system due to underlying rheumatologic conditions can result in a predisposition for hemolysis. | Systemic activation of the [[immune system]] due to underlying [[Rheumatologic disease|rheumatologic]] conditions can result in a predisposition for [[hemolysis]]. | ||
*Systemic lupus erythematosus | *[[Systemic lupus erythematosus]] | ||
====Drugs==== | ====Drugs==== | ||
These are important causes of hemolysis, especially in the era of immunotherapy for cancer. As more immunotherapeutic agents reach the market, it is likely that there will be more cases of [[iatrogenic]] hemolytic anemia. | These are important causes of [[hemolysis]], especially in the era of [[immunotherapy]] for [[cancer]]. As more immunotherapeutic agents reach the market, it is likely that there will be more cases of [[iatrogenic]] hemolytic anemia. | ||
*[[Pembrolizumab]] | *[[Pembrolizumab]] | ||
*[[Nivolumab]] | *[[Nivolumab]] | ||
*[[Ipilimumab]] | *[[Ipilimumab]] | ||
* | *Durvalumab | ||
* | *Avelumab | ||
*[[Dapsone]] | *[[Dapsone]] | ||
*[[Quinines]] | *[[Quinine|Quinines]] | ||
===Causes by Organ System=== | ===Causes by Organ System=== | ||
{|style="width:80%; height:100px" border="1" | {| style="width:80%; height:100px" border="1" | ||
| | | style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular''' | ||
| | | style="width:75%" bgcolor="Beige" ; border="1" | [[Artificial heart valve|Artificial valves]] (mechanical or bioprosthetic) that cause shear stress to [[red blood cells]] | ||
|- | |- | ||
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning''' | | bgcolor="LightSteelBlue" | '''Chemical/Poisoning''' | ||
|bgcolor="Beige"| Snake venom | | bgcolor="Beige" | [[Snake venoms|Snake venom]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dental''' | | '''Dental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dermatologic''' | | '''Dermatologic''' | ||
|bgcolor="Beige"| No underlying causes, but microangiopathy can present with dermatologic manifestations | | bgcolor="Beige" | No underlying causes, but [[microangiopathy]] can present with [[Dermatological|dermatologic]] manifestations | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''Drug Side Effect''' | ||
|bgcolor="Beige"| [[Acetaminophen and Oxycodone]], [[Amoxicillin]], [[Cefadroxil]], [[Cefaclor]], [[Cefotaxime sodium]], [[Cefotetan disodium]], [[Ceftazidime]], [[Chlorpromazine]], [[Chlorpropamide]], [[Clemastine]], [[Dexchlorpheniramine]], [[Diflunisal]], [[Doxycycline]], [[Flurbiprofen]], [[Indinavir]],[[Imipenem-Cilastatin]], [[Rifampin]], [[Mafenide]], [[Meropenem]], [[Metaxalone]], [[Micafungin sodium]], [[Minocycline hydrochloride]], [[Nitrofurantoin]], [[Olsalazine]], [[Oxaprozin]], [[Oxytetracycline]], [[Penicillin G ]] , [[Primaquine phosphate]] (in [[G-6-PD deficiency]] and in [[favism]]), [[Pegademase]], [[Piperacillin]], [[Piperacillin/tazobactam]], [[Procarbazine]], [[Probenecid]],[[Rasburicase]], [[Repaglinide]], [[Sulindac]], [[tolbutamide]], [[Tolazamide]], [[Thiothixene]], [[Tolmetin]], | | bgcolor="Beige" | [[Acetaminophen and Oxycodone]], [[Amoxicillin]], [[Cefadroxil]], [[Cefaclor]], [[Cefotaxime sodium]], [[Cefotetan disodium]], [[Ceftazidime]], [[Chlorpromazine]], [[Chlorpropamide]], [[Clemastine]], [[Dexchlorpheniramine]], [[Diflunisal]], [[Doxycycline]], [[Flurbiprofen]], [[Indinavir]],[[Imipenem-Cilastatin]], [[Rifampin]], [[Mafenide]], [[Meropenem]], [[Metaxalone]], [[Micafungin sodium]], [[Minocycline hydrochloride]], [[Nitrofurantoin]], [[Olsalazine]], [[Oxaprozin]], [[Oxytetracycline]], [[Penicillin G ]] , [[Primaquine phosphate]] (in [[G-6-PD deficiency]] and in [[favism]]), [[Pegademase]], [[Piperacillin]], [[Piperacillin/tazobactam]], [[Procarbazine]], [[Probenecid]],[[Rasburicase]], [[Repaglinide]], [[Sulindac]], [[tolbutamide]], [[Tolazamide]], [[Thiothixene]], [[Tolmetin]], | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Ear Nose Throat''' | | '''Ear Nose Throat''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| Grave's disease and other conditions characterized by antibodies against endocrine organs can rarely cause inadvertent hemolysis | | bgcolor="Beige" | [[Grave's disease]] and other conditions characterized by [[antibodies]] against [[endocrine organs]] can rarely cause inadvertent [[hemolysis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Environmental''' | | '''Environmental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Gastroenterologic''' | | '''Gastroenterologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Genetic''' | | '''Genetic''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[Hereditary spherocytosis]], [[hereditary elliptocytosis]], [[Thalassemia|thalassemias]], [[glucose-6 phosphate deficiency]], [[pyruvate kinase deficiency]], [[Triose phosphate isomerase|triose phosphate]] deficiency | ||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | |||
| bgcolor="Beige" | [[Microangiopathic hemolytic anemia]], [[Thrombotic thrombocytopenic purpura|thrombotic thrombocytopenia purpura]], [[disseminated intravascular coagulation]] | |||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Iatrogenic''' | | '''Iatrogenic''' | ||
|bgcolor="Beige"| Immunotherapy drugs used to treat cancer, such pembrolizumab, nivolumab, ipilimumab, avelumab, durvalumab | | bgcolor="Beige" | [[Immunotherapy]] drugs used to treat [[cancer]], such as [[pembrolizumab]], [[nivolumab]], [[ipilimumab]], avelumab, and durvalumab | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| Babesia, malaria, ''Clostridium perfringens'', enterohemorrhagic ''E.coli'', parvovirus | | bgcolor="Beige" | [[Babesia]], [[malaria]], ''[[Clostridium perfringens]]'', [[EHEC|enterohemorrhagic ''E.coli'']] ([[Hemolytic-uremic syndrome|hemolytic uremia syndrome]]), [[parvovirus]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal/Orthopedic''' | | '''Musculoskeletal/Orthopedic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Nutritional/Metabolic''' | | '''Nutritional/Metabolic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Obstetric/Gynecologic''' | | '''Obstetric/Gynecologic''' | ||
|bgcolor="Beige"| | | bgcolor="Beige" | [[HELLP syndrome]] ([[Hemolysis|'''h'''emolysis]], '''e'''levated '''l'''iver enzymes, [[Thrombocytopenia|'''l'''ow '''p'''latelets]]) syndrome and [[Preeclampsia|pre-eclampsia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| Anti-PD-1 agents | | bgcolor="Beige" | Anti-PD-1 agents (immunotherapeutic drugs for cancer), [[chronic lymphocytic leukemia]] (causes [[autoimmune hemolytic anemia]]) | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Ophthalmologic''' | | '''Ophthalmologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Overdose/Toxicity''' | | '''Overdose/Toxicity''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Psychiatric''' | | '''Psychiatric''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Pulmonary''' | | '''Pulmonary''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Renal/Electrolyte''' | | '''Renal/Electrolyte''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Rheumatology/Immunology/Allergy''' | | '''Rheumatology/Immunology/Allergy''' | ||
|bgcolor="Beige"| Systemic lupus erythematosis | | bgcolor="Beige" | [[Systemic lupus erythematosus|Systemic lupus erythematosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Sexual''' | | '''Sexual''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Trauma''' | | '''Trauma''' | ||
|bgcolor="Beige"| Capillary damage can result in shear stress and hemolysis | | bgcolor="Beige" | [[Capillary]] damage can result in [[shear stress]] and [[hemolysis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Urologic''' | | '''Urologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|} | |} | ||
==References== | ==References== |
Latest revision as of 18:46, 30 October 2017
Hemolytic anemia Microchapters |
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Treatment |
Case Studies |
Hemolytic anemia causes On the Web |
American Roentgen Ray Society Images of Hemolytic anemia causes |
Risk calculators and risk factors for Hemolytic anemia causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]
Overview
The causes for hemolytic anemia can be divided into intracorpuscular or extracorpuscular causes. The intrinsic causes are commonly due to hereditary causes whereas the extrinsic causes are commonly acquired. Drugs are another major cause of hemolysis. In the era of immunotherapy for cancer, drug-related causes are becoming increasingly important to recognize.
Causes
The causes of hemolytic anemia can be divided into etiologies that are intrinsic to red blood cell biology or extrinsic to red blood cell biology. Intrinsic, or intracorpuscular, causes include red blood cell membrane defects or enzyme deficiencies. Extrinsic causes include infections, autoimmune conditions, or drugs.
Intrinsic or Intracorpuscular Factors
Red blood cell membrane defects
- Paroxysmal nocturnal hemoglobinuria
- Alpha thalassemia
- Hereditary spherocytosis: This is the most common hereditary form of hemolytic anemia.[1] It is caused by mutations in red blood cell cytoskeletal proteins, such as:
- Hereditary elliptocytosis
- Unstable hemoglobin variants and hemoglobinopathies
Red blood cell enzyme deficiencies
- Glucose-6-phosphate dehydrogenase deficiency
- Pyruvate kinase deficiency
- Triose phosphate isomerase deficiency
Extrinsic Factors
Extrinsic factors refers to those that are commonly acquired in nature and have an adverse effect on red blood cells.
Infections
- Shiga-toxin from enterohemorrhagic E. coli strain O157:H&
- Parvovirus
- Malaria
- Babesia
- Clostridium perfringens
Autoimmune or rheumatologic conditions
Systemic activation of the immune system due to underlying rheumatologic conditions can result in a predisposition for hemolysis.
Drugs
These are important causes of hemolysis, especially in the era of immunotherapy for cancer. As more immunotherapeutic agents reach the market, it is likely that there will be more cases of iatrogenic hemolytic anemia.
- Pembrolizumab
- Nivolumab
- Ipilimumab
- Durvalumab
- Avelumab
- Dapsone
- Quinines
Causes by Organ System
Cardiovascular | Artificial valves (mechanical or bioprosthetic) that cause shear stress to red blood cells |
Chemical/Poisoning | Snake venom |
Dental | No underlying causes |
Dermatologic | No underlying causes, but microangiopathy can present with dermatologic manifestations |
Drug Side Effect | Acetaminophen and Oxycodone, Amoxicillin, Cefadroxil, Cefaclor, Cefotaxime sodium, Cefotetan disodium, Ceftazidime, Chlorpromazine, Chlorpropamide, Clemastine, Dexchlorpheniramine, Diflunisal, Doxycycline, Flurbiprofen, Indinavir,Imipenem-Cilastatin, Rifampin, Mafenide, Meropenem, Metaxalone, Micafungin sodium, Minocycline hydrochloride, Nitrofurantoin, Olsalazine, Oxaprozin, Oxytetracycline, Penicillin G , Primaquine phosphate (in G-6-PD deficiency and in favism), Pegademase, Piperacillin, Piperacillin/tazobactam, Procarbazine, Probenecid,Rasburicase, Repaglinide, Sulindac, tolbutamide, Tolazamide, Thiothixene, Tolmetin, |
Ear Nose Throat | No underlying causes |
Endocrine | Grave's disease and other conditions characterized by antibodies against endocrine organs can rarely cause inadvertent hemolysis |
Environmental | No underlying causes |
Gastroenterologic | No underlying causes |
Genetic | Hereditary spherocytosis, hereditary elliptocytosis, thalassemias, glucose-6 phosphate deficiency, pyruvate kinase deficiency, triose phosphate deficiency |
Hematologic | Microangiopathic hemolytic anemia, thrombotic thrombocytopenia purpura, disseminated intravascular coagulation |
Iatrogenic | Immunotherapy drugs used to treat cancer, such as pembrolizumab, nivolumab, ipilimumab, avelumab, and durvalumab |
Infectious Disease | Babesia, malaria, Clostridium perfringens, enterohemorrhagic E.coli (hemolytic uremia syndrome), parvovirus |
Musculoskeletal/Orthopedic | No underlying causes |
Neurologic | No underlying causes |
Nutritional/Metabolic | No underlying causes |
Obstetric/Gynecologic | HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclampsia |
Oncologic | Anti-PD-1 agents (immunotherapeutic drugs for cancer), chronic lymphocytic leukemia (causes autoimmune hemolytic anemia) |
Ophthalmologic | No underlying causes |
Overdose/Toxicity | No underlying causes |
Psychiatric | No underlying causes |
Pulmonary | No underlying causes |
Renal/Electrolyte | No underlying causes |
Rheumatology/Immunology/Allergy | Systemic lupus erythematosis |
Sexual | No underlying causes |
Trauma | Capillary damage can result in shear stress and hemolysis |
Urologic | No underlying causes |
Miscellaneous | No underlying causes |
References
- ↑ Jung HL (2013). "A new paradigm in the diagnosis of hereditary hemolytic anemia". Blood Res. 48 (4): 237–9. doi:10.5045/br.2013.48.4.237. PMC 3894378. PMID 24466544.