Hemolytic anemia natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

In general, the natural history, complications, and prognosis depend on the underlying cause of hemolytic anemia. Some types of hemolytic anemia have a transient course with few complications and excellent prognosis. Some types of hemolytic anemia have a lifelong course with many complications and poor prognosis.

Natural History

The natural history depends on the etiology of the hemolytic anemia.

  • Drug-induced hemolytic anemia: This tends to be transient, if the etiology is identified. Once the drug is introduced, the hemolysis typically begins within a few days. Once the offending agent is discontinued, the hemolysis begins to abate. The course is usually mild. There are typically no long-term complications from this type of hemolysis. Serologic tests, such as the direct antiglobulin test, or Coomb's test, can persist despite clinical resolution of symptoms.
  • Autoimmune hemolytic anemia: This can have a lifelong course if the etiology is not identified. This can have an unpredictable course of relapses[1] and remissions.
  • Warm autoimmune hemolytic anemia in children: This has a self-limited course when treated with steroids.[1] Steroids usually result in a rapid remission, especially if a high dose or induction dose is used. Relpases are unusual. The estimated mortality rate is 10-30%.
  • Hereditary etiologies of hemolytic anemia: Such etiologies include G6PD deficiency, red blood cell membrane defects, or red blood cell enzyme defects. These tend to manifest with lifelong symptoms, as these are difficult to cure. Patients with these types of hemolytic anemia have lifelong risk.
  • Cold agglutinin disease: This condition results in hemolysis in the presence of cold temperatures. The hemolysis begins upon exposure to cold then abates after cold temperatures are no longer present. Post-infection cold agglutinin disease typically lasts for weeks to months then resolves. Serological tests such, as the Donath-Landsteiner antibody, can persist despite clinical resolution of the hemolytic anemia.[2]

Complications

The complications depend on the specific type of hemolytic anemia.

Prognosis

The outcome depends on the type and cause of hemolytic anemia.

  • Drug-induced hemolytic anemia: The prognosis of this type of anemia is typically favorable if the offending agent is discontinued.
  • Cold agglutinin disease: This has a generally good prognosis. Patients typically survive for many years. In the case of an associated lymphoma, the prognosis can be much worse depending the type of lymphoma.[1]

References

  1. 1.0 1.1 1.2 Packman CH (2015). "The Clinical Pictures of Autoimmune Hemolytic Anemia". Transfus Med Hemother. 42 (5): 317–24. doi:10.1159/000440656. PMC 4678314. PMID 26696800.
  2. HINZ CF, PICKEN ME, LEPOW IH (1961). "Studies on immune human hemolysis. I. The kinetics of the Donath-Land-steiner reaction and the requirement for complement in the reaction". J Exp Med. 113: 177–218. PMC 2137335. PMID 13714487.
  3. 3.0 3.1 Sahu S, Verma A (2014). "Adverse events related to blood transfusion". Indian J Anaesth. 58 (5): 543–51. doi:10.4103/0019-5049.144650. PMC 4260299. PMID 25535415.
  4. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J (2015). "Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis". BMJ. 350: h1354. doi:10.1136/bmj.h1354. PMC 4372223. PMID 25805204. Review in: Evid Based Med. 2015 Oct;20(5):170

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