Hemolytic Anemias

Hemolytic anemia is a reduction, in the number of circulating red cells from their premature destruction.
Causes:
I. Genetically-determined disorders of red cells:
A. Enzyme deficiencies -- which result in abnormal energy metabolism:
1. Glucose 6-phosphate-dehydrogenase.
2. Pyruvate kinase deficiency.
3. Triosephosphate isomerase deficiency.
B. Haemoglobinopathies
1. Structural haemoglobin variants.
2. Thalassemia syndromes.
C. Disorders of the red cell membrane:
1. Hereditary spherocytosis.
2. Elliptocytosis.
3. Stomatocytosis.
4. Acanthocytosis in a-b-lipo-proteinemia.
II. Acquired disorders of red cells:
A. Associated with red cell antibodies
1. Isoantibodies -- Haemolytic disease of the newborn, transfusion reactions.
2. Autoimmune haemolytic anaemia -- Warm antibody type, drug-induced, cryopathic haemolytic syndrome.
B. Not associated with antibody formation
1. Acquired membrane defects -- paroxysmal nocturnal haemoglobinuria (PNH), liver disease, uremia, vitamin E deficiency.
2. Trauma -- microangiopathic haemolytic anemia, cardiac haemolysis, march haemoglobinuria.
3. Physical agents -- e.g. severe burns.
4. Chemical agents -- snake venom, drugs.
5. Infections -- parasitic, bacterial, disseminated intravascular coagulation.
6. Multifactorial -- Anaemia of chronic disorders, hypersplenism, malignancy including lymphomas, collagen vascular disorders.

The symptoms of this disease is depends on the course of the disease either acute or chronic. As for the acute patients, the symptoms appear spontaneously such as trembling, high fever, weakness, nausea, vomiting, abdominal pain, ache in waist, back and extremities and so on. The severe patients may even develop coma and shock, heart function insufficiency and acute renal failure. The other symptoms are severe anemia and jaundice accompanied with hemoglobinpathies and hematuria. While for the chronic patients, the course of disease starts gradually, along with weakness, headache, palpitation after physical activity and etc- similar as anemic symptoms. They have light or moderate degree of anemia, jaundice and hepatosplenomegalia (enlargement of liver and spleen). The prolonged chronic hemolytic anemia may arose cholelithiasis (formation of bile stones) and hepatic failure.
In traditional Chinese medicine studies, this disease belongs to the category of wang dan (jaundice) and xu lao (weakness). The hypofunction of spleen and stomach will cause the decreased function of Qi and blood regeneration, the weakness of Qi and blood is difficult to recover, so one will have weakness, headache, palpitation after physical activity and etc- similar as anemic symptoms; in severe cases, the patients will have weakness of kidneys Yang, when the Yang is weak, it cannot generate Yin and cause impairment of regeneration of blood s Yin. If the spleen is weak, it will cause retention of moist and fluid they accumulate and turn into heat, then the suffocation of moist and heat causing substances in the stomach to move in opposite direction, thus lead to high fever, nausea, vomiting and trembling. The interaction of moist and heat cause overflow of bile which later leads to jaundice. If the jaundice is prolonged, the moist and bad substances are accumulated which then caused the friction between Qi and blood, therefore there is enlargement of liver and spleen. Firstly, one must clear the heat and discharge the moist in their treatment, next are increase Qi, strengthen the spleen and kidneys.