Hemolytic anemia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 comonly acquired.

Causes

Common Causes

• Hemolytic anemia occurs when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells.
• If the bone marrow is able to keep up with the early destruction, anemia does not occur (this is sometimes called compensated hemolysis).
• There are many types of hemolytic anemia, which are classified by the reason for the premature destruction of red blood cells. The defect may be in the red blood cell itself (intrinsic factors), or outside the red blood cell (extrinsic factors).

Intrinsic or Intracorpuscular

• Commonly hereditary in nature exceptions, paroxysmal nocturnal hemoglobinuria and acquired alpha thalassemia
• Occurs secondary to abnormalities in RBC components such as hemoglobin, RBC membranes (alpha or beta globin chains in thalassemia, hereditary spherocytosis, paroxysmal nocturnal hemoglobinuria), glycolysis, and reducing power of the RBC.

Extrinsic factors

• Commonly acquired in nature
• Antibodies against RBC membrane such as seen in autoimmune hemolytic anemia, alloimmune hemolytic anemia, delayed [hemolytic] transfusion reaction, some drug-induced hemolytic anemias)
• RBC destructions secondary to trauma as seen in valvular malfunctioning, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome
• Infections - malaria, babesiosis, clostridium perfringens
• Oxidative stress such as aniline dyes, dapsone, pyridium in normal patients or with G6PD deficiency, congenital methemoglobinemia, or unstable hemoglobin variants.
• Hypersplenism

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen and Oxycodone, Chlorpromazine, Doxycycline, Metaxalone, Minocycline hydrochloride, Nitrofurantoin, Repaglinide, Sulindac
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
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	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes