The Process of Hemolysis and Red Blood Cell Breakdown

Hemolysis is the process of red blood cell (RBC) breakdown. Normally, your body makes new RBCs to replace those that have exceeded their healthy lifespan. Some of the materials released into your bloodstream when your RBCs decompose are used as your body makes new ones.

Sometimes, medical conditions can cause abnormal hemolysis. This can result in symptoms ranging from fatigue to dizziness to loss of consciousness—depending on the extent and cause of abnormal hemolysis. This article will describe normal and abnormal hemolysis and what to expect.

Hemolysis: What Happens Normally

Your body is constantly replenishing RBCs, and they typically last for about 120 days. This requires a healthy supply of nutrients such as protein, iron, folate, and vitamin B12.

When you’re healthy, you won’t feel the effects of RBC breakdown or regeneration. But if any part of the RBC lifecycle or renewal process is disrupted, you may develop symptoms of anemia (low RBCs). If the cause of anemia is hemolysis, you may also experience symptoms related to hemolytic processes.

Effects of Abnormal Hemolysis

The effects of abnormal hemolysis may develop gradually or can occur abruptly—this depends on the triggers for abnormal RBC disintegration. You will likely develop symptoms of anemia. Other symptoms can develop due to the accumulation of RBC breakdown products in the liver or other organs of the body.

General Symptoms

Mild hemolysis can cause gradually progressive fatigue, dizziness, pale skin, and feeling cold. Rapid hemolysis can cause hematuria (blood in the urine), a significant drop in blood pressure, and loss of consciousness.

Other symptoms can develop due to the accumulation of RBC breakdown products in the liver or other organs of the body. Examples are jaundice (yellowing of skin) or scleral icterus (yellowing of eyes).

Related Conditions

Many different medical conditions can cause hemolysis. Some of these disorders are chronic, inherited conditions that make the RBCs especially fragile. Hemolysis can also develop due to health issues that damage RBCs.

A few of the illnesses that can cause abnormal hemolysis include:

• Sickle cell disease: This condition causes abnormal RBC formation. The RBCs in sickle cell disease are susceptible to degeneration in response to infections, illness, and physical stress, which sometimes occurs without a trigger.
• Malaria: This parasitic infection is transmitted through mosquitoes. The parasites may inhabit RBCs and can cause hemolysis.
• Glucose 6 phosphate dehydrogenase deficiency (G6PDdeficiency): This inherited condition is an enzyme deficiency that causes a defect in the metabolism of certain foods (fava beans) and medications (sulfa drugs). Consuming these foods or medications leads to RBC hemolysis in people who have G6PD deficiency.
• Autoimmune disease: In rare cases, the immune system attacks a person's own RBCs, leading to hemolysis.
• Cancer: Severe illness may induce abnormal hemolysis.
• Trauma: A major traumatic injury can trigger the rapid onset of abnormal hemolysis.
• Heart disease: In general, heart disease can cause mild to moderate hemolysis that can produce symptoms of anemia.
• Kidney disease: Kidney failure can cause hemolysis, and dialysis can also increase the risk of excessive RBC degeneration.
• Blood incompatibility: A mismatched blood transfusion would cause the recipient's immune system to attack the donor RBCs, leading to a severe hemolytic emergency. A rare condition, hemolytic disease of the newborn, occurs when a pregnant person's immune system attacks the fetus's blood.
• Paroxysmal nocturnal hemoglobinuria: This rare disorder causes sudden and substantial degeneration of RBCs.

Medications That May Induce Hemolysis

Several medications can trigger hemolysis. The way that each medication leads to hemolysis differs.

Some of the medications that can cause hemolysis include:

• Aspirin
• Plavix (clopidogrel)
• Penicillin
• Ceftriaxone
• Wellbutrin (bupropion)
• Flagyl (metronidazole)

This is not a complete list of hemolysis-inducing drugs—many over-the-counter (OTC) and prescription medications can cause this reaction.

Why Does Abnormal Hemolysis Happen?

With normal hemolysis, the rate of RBC breakdown is about the same as the rate of RBC regeneration.

Conditions that lead to abnormal hemolysis disrupt the stability of the RBCs, causing them to disintegrate. This can happen as a result of toxic injury to any part of the RBC structure. A key feature of abnormal hemolysis is that symptoms usually develop when the RBCs break down faster than the body can replenish them.

Risks of Untreated Abnormal Hemolysis

An acute episode of severe hemolysis can cause substantial and irreversible organ damage—and may even result in death.

Chronic hemolytic disease may damage the joints throughout the body, sometimes causing joint aches and pains. Liver damage due to hemolysis can lead to liver dysfunction. Symptoms may include feeling generally sick, jaundice (yellowing of the eyes and skin), an enlarged abdomen, difficulty with digestion, and susceptibility to infections.

If it’s not treated, chronic hemolysis may lead to death. There are many causes of hemolysis, and the severity can vary significantly.

Hemolysis and Life Expectancy

It’s impossible to predict with certainty how this condition will affect a person’s life expectancy. Treatment can prolong survival and reduce the symptoms. Organ damage associated with hemolysis can lead to worse outcomes and a lower chance of survival.

How the Hemolysis Index Measures RBC Ranges

Anemia is diagnosed with blood tests that measure the size and concentration of RBCs in a person’s bloodstream. Additionally, measures of hemoglobin and iron can also be used to assess causes of anemia, and consideration of the overall results can be used to determine whether you have abnormal hemolysis.

Blood samples can also be examined with a microscope, which may reveal important information about the shape of RBCs and whether there are abnormal numbers of broken-down RBCs.

If you have evidence of abnormal hemolysis based on the results of your blood tests, you may also have tests to identify the cause. These tests may include genetic tests or diagnostic procedures to identify underlying risks (such as heart disease or cancer).

Treatment for Abnormal Hemolysis

Treatment for abnormal hemolysis involves replacing RBCs, treating the complications, and managing the underlying medical condition to prevent excessive RBC breakdown. For example, infections such as malaria require specific antiparasitic treatment.

In some cases, blood transfusions may benefit people who have hemolytic anemia. Blood transfusions can restore a normal RBC count, alleviating symptoms and complications.

Long Term Treatment and Prevention

The cause directs long-term treatment. For example, if you are diagnosed with sickle cell disease or an autoimmune disease, you would need individualized treatment.

The treatment of G6PD deficiency involves avoiding exposure to substances that can induce hemolysis. If a person with G6PD deficiency develops hemolytic anemia, a prompt blood transfusion may benefit them.

Prognosis for Autoimmune Hemolytic Anemia

The outcome of autoimmune hemolytic anemia is variable. This condition is quite rare, and treatment can help minimize hemolysis, reduce symptoms, and prolong life expectancy. Treatment includes blood transfusions, corticosteroids, or other immune-modifying treatments to reduce the damage caused by the overactive immune system.

If you are diagnosed with autoimmune hemolytic anemia, you need to have ongoing surveillance of your RBC measures, and your treatment may need to be adjusted based on the severity and fluctuation of your condition.

Living Well With Abnormal Hemolysis

Abnormal hemolysis is a dangerous consequence of several different medical disorders. If diagnosed with abnormal hemolysis, you can have a healthy life and a good outcome. It would be best to keep up with your medical care and monitoring to prevent symptoms or severe consequences of your disease.

Additionally, lifestyle factors can help prevent anemia:

• Get your recommended vaccinations on schedule so you can avoid infections.
• Pay attention to handwashing, wearing a mask if you’re going to be around large groups, staying away from people who may have contagious infections, washing fruit and vegetables thoroughly, and avoiding uncooked meat or seafood to reduce your risk of infections.
• Eat a balanced diet that includes protein, iron, folate, and vitamin B12 so your body will have an ample supply of the components used to build RBCs.
• Don’t smoke.
  

Summary

Hemolysis is a normal part of the RBC lifespan as aging RBCs disintegrate. Abnormal hemolysis can occur as a consequence of many different medical conditions. If your RBC breakdown exceeds your RBC production, you can experience symptoms such as fatigue, dizziness, pale skin, and feeling cold.

If you develop extreme hemolytic anemia, you may develop low blood pressure, loss of consciousness, and organ damage. Routine blood tests can help detect signs of hemolysis.

If you develop any symptoms, it’s important that you see a healthcare provider so you can be diagnosed and treated before serious consequences occur.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Heidi Moawad, MD
Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

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