What are the signs and symptoms of hemolytic anemia?

Updated: May 27, 2021
  • Author: Srikanth Nagalla, MD, MS, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Signs and symptoms of hemolytic anemia are diverse and are due to anemia, the extent of compensation, previous treatment, and the underlying disorder. Patients with minimal or long-standing hemolytic anemia may be asymptomatic, and hemolysis is often found incidentally during routine laboratory testing. Clinical manifestations may include the following:

  • In intravascular hemolysis, iron deficiency due to chronic hemoglobinuria can exacerbate anemia and weakness

  • Tachycardia, dyspnea, angina, and weakness occur in patients with severe anemia, as cardiac function is sensitive to anoxia

  • Persistent hemolysis may result in the development of bilirubin gallstones; these patients may present with abdominal pain

  • Bronze skin color and diabetes occur in hematosiderosis; iron overload may occur in patients who have received multiple transfusions or those who have been administered iron therapy erroneously

  • Dark urine may be due to hemoglobinuria

  • In addition to hemolysis, patients with thrombotic thrombocytopenic purpura (TTP) may experience fever, neurologic signs, renal failure, and thrombocytopenia

  • Leg ulcers may develop in patients with sickle cell anemia and other hemolytic disorders, as a result of decreased red blood cell (RBC) deformability and endothelial changes

  • Venous thromboembolism occurs in 15% to 33% of adults with warm autoimmune hemolytic anemia, especially in the first few weeks after onset [31]

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