The normal life span of red blood cells is about 120 days. Anemia only occurs when the life span of red blood cells is shortened to 15-20 days.

Anemia occurs due to the increased destruction rate of red blood cells (shortened life span) and exceeding the compensatory capacity of bone marrow hematopoiesis.

If the red blood cell destruction rate is within the compensatory range of the bone marrow, hemolysis will occur but anemia will not occur.

The presence or absence of jaundice depends on the degree of hemolysis and the liver's ability to process bilirubin.

Hemolytic anemia does not necessarily mean jaundice

1) Acute hemolysis

2) Chronic hemolysis

See clinical manifestations

1) Intravascular hemolysis

2) Extravascular hemolysis

3) In situ hemolysis: young red blood cells are destroyed in the bone marrow

See pathogenesis

(1) HA caused by abnormalities in red blood cells themselves

(2) HA caused by external factors of red blood cells

I Intravascular hemolysis

II extravascular hemolysis

III in situ hemolysis

Mostly intravascular hemolysis, onset is sudden

1) Headache, vomiting, high fever

2) Soreness in lower back, limbs and abdominal pain

3) Soy sauce color urine

4) Pale complexion and jaundice

5) Severe cases include peripheral circulatory failure, oliguria, and anuria

Mostly extravascular hemolysis, with slow onset and mild symptoms.

1) Characteristics: anemia, jaundice, splenomegaly

2) Can be complicated by cholelithiasis and liver function damage

3) Extramedullary hematopoiesis can cause liver and splenomegaly

4) Expansion of the bone marrow cavity, thinning of the bone cortex, and bone deformation

I Intravascular hemolysis

II extravascular hemolysis

I Reticulocyte count

II bone marrow

III peripheral blood

I Red blood cell survival time is shortened

II lactate dehydrogenase

Diagnostic steps

I Medical history

II Clinical Manifestations

III One of the following situations exists

1) Anemia with reticulocytosis: such as early recovery from hemorrhagic, iron deficiency or megaloblastic anemia

2) Non-bilirubinuric jaundice: such as familial non-hemolytic jaundice

3) Myelocytic anemia with mild reticulocytosis: such as bone marrow metastasis

1) Discontinue medication

2) Control infection

1) Adrenocortical hormone

2) Splenectomy

3) Immunosuppressants: cyclosporine A, cyclophosphamide, etc.

4) Blood transfusion: Autoimmune hemolytic anemia and PNH require transfusion of washed red blood cells.

5) Other treatments: prevention and treatment of acute renal failure, shock and electrolyte imbalance in acute hemolysis