Key Terms: Erythrocytes, Erythropoietin, Hemolysis, Spherocytosis, Stem cells.
Description
Red blood cells (erythrocytes) transport oxygen and carbon dioxide in the bloodstream, maintain a normal acid-base balance, and determine how thick or thin the blood is. Hemolytic anemia refers to the premature, increased destruction of erythrocytes. Hemolysis is the rupture of these erythrocytes with the release of hemoglobin into the plasma, and anemia is a reduced delivery of oxygen to the tissues. Some of the symptoms of hemolytic anemia include nosebleeds, bleeding gums, shortness of breath, fatigue, rapid heartbeat, pale skin color or yellow skin color (jaundice), chills, and dark-colored urine.
Causes
Erythrocyte (red blood cell) formation takes place in the red bone marrow in an adult and in the liver, spleen, and bone marrow of the fetus. Their formation requires an adequate supply of iron, cobalt, copper, amino acids, and certain vitamins. When the bone marrow loses its ability to compensate for the destruction of the erythrocytes by increasing their production, hemolytic anemia occurs. There are many types of hemolytic anemia, which are classified according to the location of this inability to produce red blood cells. If the problem lies within the red blood cell itself, it is referred to as an intrinsic factor, and if the problem is outside the red blood cell, it is referred to as an extrinsic factor. The overall incidence of hemolytic anemia is approximately 4 per 100,000 people.
Rh factor incompatibility refers to genetically determined substances capable of producing an immune response (antigens). This can cause hemolytic anemia not only during pregnancy when the mother is Rh negative and the fetus is Rh positive, but in mismatched blood transfusions as well. There are a number of industrial poisons that produce hemolytic anemia. These include:
- antimalarial agents
- organic solvents (benzene)
- certain chemotherapies
- hypersensitivity to certain antibiotics
- metals (chromium, platinum salts, nickel, lead, copper)
- Pyridium
- arsenic
- intravenous (IV) water (an IV that is not normal or half-normal saline)
- snake bites (if the venom contains hemolytic toxins) These are all factors external to the red blood cell and thus are extrinsic in nature.
One important extrinsic factor in the cause of hemolytic anemia is in the course of widespread cancer, leukemia, Hodgkin's disease, acute alcoholism and liver disease. Many of the chemotherapy agents (cisplatin, carboplatin and nonplatinum drugs) utilized in treating various cancers have side effects that cause a suppression of bone marrow activity, which results in severe hemolytic anemia. In essence, an individual is not only anemic as a result of cancer, but this anemia is worsened by the treatment. Since nausea, vomiting, and lack of appetite are also side effects of chemotherapy, it is extremely difficult for the patient to overcome this anemia with diet and supplements. Eventually, severe hemolytic anemia is the end result.
Intrinsic factors would include disorders in the immune response and genetically inherited disorders such as glucose-6-phosphate dehydrogenase deficiency, an essential enzyme. People with this disorder do not display any symptoms until exposed to certain medications or stress. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can precipitate this reaction. This disorder is more common among African-American males, with approximately 10% to 14% of the population being affected. Other genetic disorders include sickle cell anemia, thalassemia, and spherocytosis. All of these produce structurally abnormal red blood cells to varying degrees.
Treatments
The treatment depends upon the cause and severity of the anemia. Medicines like folic acid and corticosteroids may be used to treat the anemia if it is not severe. Severe hemolytic anemia may be very quickly fatal and immediate hospitalization is required for transfusion of washed and packed red blood cells. Severe anemias can aggravate pre-existing heart disease, lung disease and cerebrovascular disease.
Frequently with cancer treatments, a patient may undergo numerous blood transfusions to accomodate for the severe anemia suffered as a result of chemotherapy. Researchers, investigating ways to enhance the quality of life for chemotherapy patients, have primarily looked at controlling pain and loss of appetite (anorexia). Recent studies, however, have examined the use of erythropoietin (a protein hormone that stimulates red blood cell production) in improving fatigue symptoms and enhancing overall quality of life. Once-weekly therapy with erythropoietin was found to increase hemoglobin levels, decrease transfusion requirements, and improve quality of life in patients with cancer and anemia undergoing chemotherapy.
Alternative and Complementary Therapies
Since there is no known prevention for hemolytic anemia, there is relatively little that can be done except to be aware of the risk factors and know the potential for genetic disorders within the family. Avoiding exposure to chemicals that precipitate the reaction, eating natural, whole grain foods, avoiding stress, and taking vitamin supplements can be helpful. With cancer patients, yoga and meditation provide a means of enhancing relaxation, reducing stress, and incorporating visualization for healing. Those patients who attend and participate in support groups have an increased quality of life with better outcomes from treatments.
Resources
Books
Jarvis, Carolyn. Physical Examination and Health Assessment. Philadelphia: W.B. Saunders Company, 2000.
Periodicals
Gabrilove, J.L., C.S. Cleeland, R.B. Livingston, et al. "Once-Weekly Dosing of Epoetin Alfa in Chemotherapy Patients." Journal of Clinical Oncology 19 (2001): 2875–82.
Mantovani, L., G. Lentini, B. Hentschel, et al. "Treatment of Anaemia in Myelodysplastic Syndromes." British Journal of Haematology 109 (2000): 367–75.
Osoba, D. "Health-Related Quality-of-Life Assessment in Clinical Trials." Support Care Cancer 8 (2000): 84–8.
Parsons, S.K. "Hematopoietic Growth Factors for Children With Cancer." Current Opinions in Pediatrics 12 (2000): 10–7.
—Linda K. Bennington, C.N.S., M.S.N.
