What is hemolytic anemia in children?

Hemolytic anemia is a group of disorders in which the red blood cells are destroyed faster than the bone marrow can make them. The term for destruction of red blood cells is hemolysis.

What causes hemolytic anemia in a child?

Hemolytic anemia has 2 types of causes:

• Intrinsic. This is when the destruction of red blood cells is due to a flaw within the red blood cells. This type is often inherited. It includes sickle cell anemia, thalassemia, or abnormal enzymes in the red blood cells. These conditions produce red blood cells that don't live as long as normal red blood cells.

• Extrinsic. This is when the destruction of red blood cells is from a cause outside of the cells. This is also called autoimmune hemolytic anemia. Some of the causes are:

  • Infections from bacteria or viruses

  • Medicines such as antibiotics like penicillin or sulfonamides, medicines for malaria, or acetaminophen

  • Cancers such as leukemia, lymphoma, or other tumors

  • Autoimmune disorders such as systemic lupus erythematous (SLE or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis

  • Hypersplenism, a condition in which the spleen destroys more red blood cells than normal

Some types of extrinsic hemolytic anemia are short-term (temporary) and go away over several months. Other types can become long-term (chronic) with periods of remissions and recurrence.

What are the symptoms of hemolytic anemia in a child?

These are the most common symptoms of hemolytic anemia:

• Pale skin

• Yellowing of the skin and eyes (jaundice)

• Dark-colored urine

• Fever

• Weakness

• Dizziness

• Confusion

• Can't handle physical activity

• Enlargement of the spleen and liver

• Fast heartbeat

• Heart murmur

These symptoms may be caused by other health problems. Always check with your child's healthcare provider for a diagnosis.

How is hemolytic anemia diagnosed in a child?

Your child’s healthcare provider may suspect hemolytic anemia from your child's health history and a physical exam. Your child may have these tests:

• Hemoglobin and hematocrit.  This test measures the amount of hemoglobin and red blood cells in the blood.

• Complete blood count (CBC).  This test checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.

• Peripheral smear. A small sample of blood is viewed under a microscope. Blood cells are checked to see if they look normal or not.

• Other blood tests.  These tests will check for lactate dehydrogenase, bilirubin, and haptoglobin, which can causes ongoing hemolysis. Certain tests can find antibodies that cause hemolysis.

• Urine tests. These tests can check for hemoglobin from red blood cells breaking down.

• Bone marrow aspiration, biopsy, or both.  This test looks at a small amount of bone marrow fluid (aspiration), solid bone marrow tissue (called a core biopsy) often from the hip bones, or both. The test checks for the number, size, and maturity of blood cells. It may also look for abnormal cells.

How is hemolytic anemia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

A child with hemolytic anemia is often treated by a hematologist. This is an expert in blood disorders. The treatment for hemolytic anemia will vary depending on the cause of the illness and how severe the anemia is. Some children don't need treatment. For those that do, treatment may include:

• Blood transfusions

• Corticosteroid or steroid medicines

• Intravenous immune globulin (IVIg)

• Rituximab, a medicine to control the immune system

• Antibiotics to treat the infection if that's the underlying cause

• Other medicines, depending on the type of hemolytic anemia

In some children who don't respond to other therapy, these treatments may be needed:

• Splenectomy.This is surgery to remove the spleen.

• Immunosuppressive therapy.This is the use of other medicines to control the immune system.

• Plasmapheresis. This is the removal of antibodies from the blood that are destroying red blood cells.

• Stem cell transplant.  In severe cases, abnormal bone marrow cells are replaced with donor bone marrow.

What are possible complications of hemolytic anemia in a child?

Complications depend on the cause of the hemolytic anemia and include:

• Side effects of medicines. For instance, the increased risk of infection with corticosteroids.

• Gallstones or stones in the gallbladder

• Blood clots and blood clots in the lungs (pulmonary emboli)

• Kidney failure

• Shock

• Heart failure

How can I help my child live with hemolytic anemia?

Managing hemolytic anemia depends on how severe the symptoms are. Children with mild symptoms will have regular blood checks.

Managing children with more severe symptoms is more complex. These children will also have their blood checked regularly. They may have trouble with daily activities due to their symptoms or treatment. If your child is taking medicine that increases the risk of infection, they should stay away from people who are sick.

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child's behavior changes. For instance, your child may not be able to be as active as normal. Also call your child's provider if your child has yellowing of the skin, dark urine, or a fever.

Key points about hemolytic anemia in children

• Hemolytic anemias are a group of conditions in which red blood cells are destroyed.

• Hemolytic anemia may be an inherited condition. Or it may be from autoimmune conditions, infections, cancers, or medicines.

• A child may need tests done to confirm the diagnosis. These may include blood tests, urine tests, and bone marrow aspiration or biopsy.

• Some children don't need treatment. If they do, common treatments are blood transfusions, steroids, and other medicines.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.