1.What is hemolytic anemia?
The average life span of mature red blood cells is usually 120 days. When the human body increases the destruction of red blood cells due to drugs, environment, abnormal defects, immune abnormalities and other factors, and exceeds the compensatory capacity of the bone marrow to produce red blood cells, it will lead to the occurrence of anemia, namely hemolytic anemia (referred to as hemolytic anemia). For example, the familiar fava bean disease is actually a kind of hemolytic anemia, and others include immune hemolytic anemia, thalassemia, sickle cell anemia, etc. Hemolytic anemia in the elderly is easily seen in the age of 70-80.
2.How do I know that I may have hemolytic anemia?
The onset of hemolytic anemia varies, and the clinical manifestations are often masked by the manifestations of the primary disease. So, how can we find out early that we may have hemolytic anemia? The following aspects can be used for self-examination. Since the anemia is caused by hemolysis, first of all, the signs of hemolysis are often important for identification. Many patients will show that the color of urine becomes strong tea-like or even coffee-colored; some of them appear yellowing of the whites of the eyes, or even yellowing of the skin and nails; soreness of the back and limbs, accompanied by headache, vomiting, chills and high fever, etc. However, clinically it is also seen that some patients with atypical symptoms do not have hemolysis, general discomfort and other manifestations, and only an abnormal increase in reticulocytes is found during physical examination. After a clear diagnosis, the next step should be to identify the cause, especially to exclude those caused by chronic lymphocytic leukemia or lymphoma.
3.What are the causes of autoimmune hemolytic anemia?
Autoimmune hemolytic anemia can be divided into two categories: primary and secondary. Primary has no clear cause, while secondary is related to immunity, tumor, infection and other factors. These include: systemic lupus erythematosus, rheumatoid arthritis, scleroderma, ulcerative colitis, myasthenia gravis, autoimmune thyroiditis; lymphoma, leukemia, plasma cell disease, histiocytosis, certain solid tumors; viral infections, mycoplasma pneumonia, tuberculosis, subacute bacterial endocarditis, syphilis, etc. Therefore, for autoimmune hemolytic anemia that is difficult to specify the cause, it should be considered from many aspects to exclude the possibility of malignant diseases, and not to treat the headache or the foot.
4. Can blood transfusion be given for immune hemolytic anemia? What should I pay attention to?
In case of hemolytic anemia, especially immune hemolytic anemia, blood transfusion can indeed replenish the insufficient red blood cells in the body and improve the patient’s symptoms, but there are great risks involved and special care should be taken. This is due to the presence of a large number of complement components in the body of immune hemolytic anemia patients, which can attack and destroy red blood cells. Once external red blood cells are imported, this will only further increase the source of complement, aggravating the hemolytic process and even threatening the patient’s life. In this regard, transfusion of red blood cell components is only considered for particularly severe hemolysis, and washed red blood cells are preferred. For patients with mild hemolysis, hormones and high-dose gammaglobulin shock therapy are generally considered.
5.What is “sericea” and how is it related to hemolytic anemia?
Fava bean disease is a form of hemolytic anemia, which is associated with a deficiency of G-6-PD in the red blood cells of the patient, often occurring suddenly within a few hours to a few days after eating fresh fava beans. It has been identified that fava beans are rich in fava bean pyrimidine glucoside and isoamylaminobarbituric acid glucoside, and that fava bean pyrimidine and isoamylaminobarbituric acid, which are produced under the action of β-glucosidase, are the two main substances that cause G-6-PD deficiency in erythrocyte hemolysis. The prodromal manifestations of the disease are general malaise, anorexia, mental lethargy, fever, dizziness, nausea and vomiting, etc., which last 1-2 days, and many of them may recover on their own without obvious symptoms. Severe cases may occur shock, coma, systemic failure, etc., should be given great attention. Patients with a history of “fava bean disease” should refrain from eating fava beans, once accidentally eaten, you need to be vigilant and promptly do the relevant examination.
6.What drugs may induce hemolytic anemia?
It should be noted that many drugs may induce hemolytic anemia, such as sulfonamides, penicillin, tetracycline, rifampin, cephalexin, erythromycin, omeprazole, etc. Pharmacological hemolytic anemia can be divided into two categories: non-immune and immune. Therefore, for patients with a history of hemolytic anemia, drugs should be selected especially carefully.
7.What tests and diagnosis should be done for hemolytic anemia?
The diagnosis of hemolytic anemia can be roughly divided into 5 steps: firstly, the initial screening test for hemolysis to determine whether it is a hemolytic disease; then the medical history investigation, including clinical symptoms, physical symptoms and family history; then the routine laboratory tests for hemolysis; further special laboratory tests for hemolysis (such as coombs, ham’s test, etc.) should be performed if the diagnosis is still unclear, as well as the necessary Finally, according to the above results, the type and cause of hemolysis will be confirmed.
8.How to prevent drug-induced hemolytic anemia?
The main way to prevent drug-induced hemolytic anemia is that the patient must avoid taking drugs that can induce hemolytic anemia. If hemolysis has already occurred after taking the drug, the drug should be stopped immediately and all drugs that can induce hemolytic attacks should be avoided. If the hemolysis and anemia are not serious, the hemolysis is self-limiting and usually stops on its own after 7 to 10 days of onset. If G-6-PD activity is very low, hemolysis is not self-limiting and anemia is severe, blood transfusion should be given. Care should be taken to strictly use blood donors who are not G-6-PD deficient, especially in areas with high prevalence of G-6-PD deficiency, otherwise transfusion can cause more serious hemolysis. If there is hemoglobinuria or oliguria, more water should be encouraged or appropriate fluid should be supplemented to keep the blood pressure normal, while alkaline drugs can be added to make the urine alkaline response. It is important to pay attention to the balance of electrolytes, especially potassium. Vitamin E has an antioxidant effect and helps to stop hemolysis. Most patients can safely pass through the hemolytic attack and the blood picture gradually returns to normal.
9.What diseases should be distinguished from hemolytic anemia?
Hemolytic anemia should be distinguished from the following diseases: (1) anemia with reticulocytosis, such as early recovery of hemorrhagic, iron deficiency or megaloblastic anemia; (2) non-bilirubinuric jaundice, such as familial non-hemolytic jaundice; (3) young granulocytic anemia with mild reticulocytosis, such as bone marrow metastases. The clinical manifestations of the above cases are similar to hemolytic anemia, but the essence is not hemolysis, so they should be distinguished.
10.What should I pay attention to in terms of diet if I have the disease?
Patients should pay attention to rest, and should not eat acidic food such as pork, beef, chicken, egg yolk, carp, peanut, beer, etc. during hemolytic attack; do not eat spicy and irritating food, drink and smoke, do not drink coffee and strong tea; alkaline food such as tofu, kelp, milk, various vegetables and fruits are suitable. During the period of immunosuppressive therapy, attention should be paid to the clean care of skin and mucous membranes, keeping the mouth clean and preventing perianal infections; patients can be properly active during the recovery period, but not overly fatigued. In addition, patients should adhere to the medication treatment, regular follow-up, pay attention to the prevention of colds, and seek medical attention once scleral yellowing or changes in urine color are detected.