Hemolytic crisis

Alternative names
Hemolysis - acute

Definition
Hemolytic crisis is the rapid destruction of red blood cells (hemolysis) beyond that for which the body can compensate by increasing blood cell production.

Considerations

Rapid destruction of red blood cells (RBCs) can be triggered in a wide variety of conditions, both because of defects within the cell and abnormalities in the blood environment. These conditions are called hemolytic anemias.

Anemia is present because there is always some degree of hemolysis with resulting decreased hematocrit. In some hemolytic anemias, such as glucose-6-phosphate dehydrogenase deficiency (G6PD), exposure to certain chemicals can synchronize the destruction of the RBCs.

Massive RBC destruction causes an acute (and often profound) anemia because the body is unable to compensate by making enough blood cells to replace those destroyed. This can also cause overloading of the kidneys with free hemoglobin. Hemolytic crises in G6PD can be fatal.

Common Causes

• Glucose-6-phosphate dehydrogenase deficiency
  
• Membrane defects in RBCs
  
• Immune hemolytic anemia
  
• Sickle cell disease

Call your health care provider if

• Your urine appears red, red-brown, or brownish (tea-colored) due to hemoglobin in the urine.
  
• You experience fatigue, pale skin, or other symptoms of anemia, especially if they worsen or if new symptoms develop.
  
• You notice a decrease in the volume of urine produced.

Emergency treatment may be necessary. This may include hospitalization, administration of oxygen, blood transfusions, and other treatments.

When your condition is stable, your medical history will be obtained and a physical examination will be performed.

Medical history questions documenting hemolytic crisis in detail may include the following:

• When did you first notice symptoms?
  
• What symptoms did you notice?
  
• Do you have a known medical history of a hemolytic anemia, G6PD deficiency, or kidney disorder?
  
• Have you ever experienced this before?
  o Was hospitalization required?
  o What was the treatment?
  o What was the outcome?

Diagnostic tests may include the following:

• CBC
  
• Blood chemistry studies to check the kidney function (BUN and creatinine level)
  
• Kidney or abdominal ultrasound
  
• Kidney or abdominal CT scan
  
• Other tests depending on the suspected cause of the hemolytic crisis

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