What’s the Difference Between Anemia and Hemolytic Anemia?

Anemia and hemolytic anemia are both conditions that result in too few red blood cells (RBCs). Their causes are different, but both have similar symptoms and can lead to long-term complications.

Anemia is a condition where your body doesn’t have enough healthy RBCs. Your RBCs are what carry oxygen from your lungs and through your body. If you have anemia, you can have shortness of breath, headaches, fatigue, or an irregular heartbeat.

There are several types of anemia, as well as various causes.

Hemolytic anemia is a type of anemia where your RBCs are destroyed faster than they ’ re made. It can develop over time or suddenly, and it can range from mild to severe.

Read on to learn more about the differences between anemia and hemolytic anemia.

What is hemolytic anemia?

Hemolytic anemia is when your body attacks healthy RBCs faster than it can create new ones. The low RBC count then leads to anemia.

There are two main types of hemolytic anemia: inherited and acquired.

Inherited

This is a genetic condition that results from a flaw in the RBC itself. In these types of anemias, the body destroys the RBCs prematurely.

Some examples of inherited anemias are:

• sickle cell disease
• thalassemia
• pyruvate kinase deficiency
• glucose-6-phosphate dehydrogenase deficiency

Acquired

This is due to something outside the RBC, such as an autoimmune condition or a medication. In this type of hemolytic anemia, RBCs are usually created healthy but then destroyed in the bloodstream or prematurely recycled in the spleen.

Types of acquired hemolytic anemias include:

• immune hemolytic anemia
• autoimmune hemolytic anemia
• alloimmune hemolytic anemia
• drug-induced hemolytic anemia
• mechanical hemolytic anemias
• paroxysmal nocturnal hemoglobinuria
• malaria, babesiosis, and other infectious anemias

Signs and symptoms

Often, anemia and hemolytic anemia won’t have obvious symptoms. If symptoms do develop, they may happen gradually or suddenly.

Symptoms of general anemia may include :

• extreme fatigue
• paleness
• chills
• shortness of breath
• headache
• dizziness and fainting
• bleeding

Signs and symptoms that could indicate hemolytic anemia may include :

• dark urine
• rapid heartbeat
• fever
• enlarged spleen or liver
• jaundice , or yellowing of the skin

Causes

There are many different causes of anemia, but anything that changes the balance between RBC creation and destruction can cause anemia.

Some causes of anemia include:

• iron deficiency
• medications
• inflammatory bowel disease
• certain cancers
• chronic health conditions

Hemolytic anemia occurs when you have too few RBCs due to too much RBC destruction (hemolysis) in the body. This can be due to :

• autoimmune conditions
• bone marrow failure
• blood transfusion complications
• infections
• vitamin B12 deficiency
• inherited conditions, such as thalassemia or sickle cell disease
• certain medications
• heart valve replacement or repair

Risk factors

Although anyone can develop anemia, certain people are at higher risk than others.

People who are more likely to experience anemia include:

• older adults
• anyone with a family history of the condition
• pregnant and menstruating people
• people who take certain medications

Hemolytic anemia is less common. It usually affects those who:

• have autoimmune conditions
• take certain medications
• need frequent blood transfusions
• have inherited blood conditions

Diagnosis

The most accurate way to reach a diagnosis of anemia or hemolytic anemia is through blood tests.

If your doctor suspects anemia, the first test they order will be a complete blood count . This test will show any signs of anemia and will look at red and white blood cells, platelet count, hemoglobin (a blood protein), and your hematocrit .

If those results indicate anemia, your doctor may order additional tests, like:

• Reticulocyte count: This is a measure of how many young RBCs are in your blood. If this is high, it means your bone marrow is working hard to make up for the destroyed cells.
• Lactase dehydrogenase: This is an enzyme present in RBCs. The level rises when RBCs are destroyed.
• Bilirubin test: Your liver produces bilirubin , and levels rise when RBCs are destroyed.
• Haptoglobin test: This protein gets rid of damaged RBC waste. These levels will be low if you’re using up haptoglobin.
• Coombs test: This direct antiglobulin test can confirm if your body is making antibodies against your RBCs.
• Eluate assessment: This lab test investigates the RBC membrane. Based on its reaction, it can confirm a diagnosis of hemolytic anemia.
• Peripheral blood smear: This test examines your blood under a microscope to see if your body is destroying your blood cells.

Treatment

Treatment for anemia and hemolytic anemia will depend on the cause. Often, starting treatment for any underlying condition can resolve the issue.

If the anemia isn’t due to an underlying condition, treatment may include :

• Vitamin supplements: Doctors recommend these for iron, B9, or B12 deficiency anemia.
• Blood transfusion: This is sometimes effective for aplastic or sickle cell anemias. It can also help with anemias due to blood loss, such as those resulting from a wound or a gastrointestinal bleed.
• Bone marrow transplant: This procedure can replace faulty blood-forming stem cells with healthy cells.
• Surgery: This can repair any internal bleeding, usually in the gastrointestinal area.

Treatment specifically for hemolytic anemia may involve:

• Corticosteroids: Corticosteroids are often a first-line treatment and are effective in 85% of cases . However, long-term use may have serious side effects.
• Rituximab: Rituximab is a medication that can treat some autoimmune conditions. Its effects may be long-lasting and can be useful for people whose condition stops responding to corticosteroids.
• Immunosuppressants: Immunosuppressant medications can help if rituximab doesn’t help or is unavailable.
• Splenectomy: Spleen removal is usually the last option, but it can offer long-term remission. It’s a less popular option, however, as it carries a higher risk of infection.

When to contact a doctor

If you think you have anemia or hemolytic anemia, the earlier you begin treatment, the better. Both anemia and hemolytic anemia can have serious health consequences without treatment.

Making changes in your diet, taking certain supplements, or trying medications can often resolve anemia. Usually, it’s a short-term condition that’s treatable once a doctor has found the underlying cause.

It’s a good idea to contact a doctor if you experience:

• chest pain
• a feeling of impending doom
• heart palpitations
• chills
• extreme paleness
• shortness of breath

The bottom line

Anemia is a condition where your body doesn’t have enough healthy RBCs. It can range from mild to severe and lead to symptoms such as fatigue, chills, or shortness of breath.

Hemolytic anemia is a type of anemia where RBCs are destroyed faster than they can be produced. Sometimes, this is due to an underlying condition, but other times, there’s no known cause.

Often, both hemolytic anemia and general anemia will resolve if you take steps to treat the underlying cause. If no underlying condition is present, various treatment options can either manage or resolve the anemia.