Understanding Haemolytic Anaemia: Evaluation and Diagnosis

Haemolytic anaemia is a state whereby red blood cells’ duration of existence is reduced through their premature removal. It is expected that the red blood cells should last for about 120 days in the blood circulation; however, during haemolytic anaemia where one of the cells is being cleared, it cannot be replaced at once since a shortage is noted. All inheritances and acquired diseases are possible and symptoms depend on what they can be – light or severe, potentially fatal ones. 

Causes of Haemolytic Anaemia 

Haemolytic anemia can be broadly categorized into two types based on the origin of the haemolysis: Among the two such types, intrinsic and extrinsic motivation types are more familiar. 

• Intrinsic Causes: These are diseases in which there are hereditary abnormalities of the RBCs and in which the RBCs are in one way or the other not suitable to be passed on to the next generation.
• Hereditary spherocytosis: A state that makes the RBCs have an abnormal round shape instead of the normal biconcave disc form of the RBCs, this makes them fragile and easily fragmented. 
  G6PD deficiency: An autosomal inherited pathologic state of an enzyme called glucose-6-phosphate dehydrogenase which has the function of protecting RBCs from damage. 
  Sickle cell anaemia: An anaemia that alters the structure of RBCs into a sickle form that predisposes the cells to pile up at the base of blood vessel walls thus interfering with blood flow and causing severe and often life-threatening symptoms and manifestations.
• Extrinsic Causes: These are diseases that emerge after exposure to agents that disrupt RBCs. 
  Autoimmune haemolytic anaemia (AIHA): These are defensive structures that work on RBCs as a person’s body shields.
• Infections: Some illnesses like malaria for instance have an impact whereby they destroy the RBCs.
• Medications and toxins: The agents that cause haemolysis include; Certain drugs – these include methyldopa quinine, sulfonamides, some non – steroidal anti-inflammatory drugs such as aspirin and ibuprofen to mention but a few. 

Symptoms of Haemolytic Anaemia 

There are usually some general signs that are evident in individuals with haemolytic anaemia, though the manifestation may differ depending on the severity of the condition and the cause. Common symptoms include: 

• Fatigue and weakness 

• Shortness of breath 

• Pale or yellow colour of the skin due to non-implementation of liver function (jaundice). 

• Dark urine 

• Enlarged spleen (splenomegaly) 

• Rapid heart rate 

Acute haemolytic anaemia has potential complications of heart failure or shock due to early onset and rapid destruction of red blood cells. 

Evaluation and Diagnosis

Diagnosing haemolytic anaemia consists of several steps:  

Past Medical history and Current Physical Examination

In all patients it is required to review the patient’s medical history to check for signs of haemolytic disorders.

• Laboratory Tests
• Complete Blood Count (CBC)
• Reticulocyte Count
• Peripheral Blood Smear
• Bilirubin Levels
• Lactate Dehydrogenase (LDH)
• Haptoglobin Levels
• Specialized Tests
• Direct Antiglobulin Test (DAT) or Coombs Test
• G6PD Enzyme Assay
• Osmotic Fragility Test
• Haemoglobin Electrophoresis
• Imaging Studies

Ultrasound or CT scan: Such diagnostic procedures can include the determining of the spleen and a liver size and the identification of pathological alterations.
Treatment of Haemolytic Anaemia

The measures for managing haemolytic anaemia vary by the cause and severity of the condition. Common treatment approaches include:

• Addressing the Underlying Cause
• Supportive Care
• Splenectomy

Conclusion

Haemolytic anaemia requires timely evaluation and diagnosis to prevent severe complications. Identifying underlying causes through blood tests and clinical assessments helps guide effective treatment. Early intervention and proper management can improve patient outcomes, emphasizing the importance of seeking medical attention at the first signs of symptoms.