Hemolytic Anemia

  1. General information
    1. A category of diseases in which there is an increased rate of RBC destruction.
    2. May be congenital or acquired.
      1. Congenital: includes hereditary spherocytosis, G6PD deficiency, sickle cell anemia, thalassemia
      2. Acquired: includes transfusion incompatibilities, thrombotic thrombocytopenic purpura, disseminated intravascular clotting, spur cell anemia
    3. Cause often unknown, but erythrocyte life span is shortened and hemolysis occurs at a rate that the bone marrow cannot compensate for.
    4. The degree of anemia is determined by the lag between erythrocyte hemolysis and the rate of bone marrow erythropoiesis.
    5. Diagnosis is based on laboratory evidence of an increased rate of erythrocyte destruction and a corresponding compensatory effort by bone marrow to increase production.
  2. Medical management
    1. Identify and eliminate (if possible) causative factors
    2. Drug therapy
      1. Corticosteroids in autoimmune types of anemia
      2. Folic acid supplements
    3. Blood transfusion therapy
    4. Splenectomy (see below)
  3. Assessment findings
    1. Clinical manifestations vary depending on severity of anemia and the rate of onset (acute vs chronic)
    2. Pallor, scleral icterus, and slight jaundice (chronic)
    3. Chills, fever, irritability, precordial spasm, and pain (acute)
    4. Abdominal pain and nausea, vomiting, diarrhea, melena
    5. Hematuria, marked jaundice, and dyspnea
    6. Splenomegaly and symptoms of cholelithiasis, hepatomegaly
    7. Laboratory tests
      1. Hgb and hct decreased
      2. Reticulocyte count elevated (compensatory)
      3. Coombs' test (direct): positive if autoimmune features present
      4. Bilirubin (indirect): elevated unconjugated fraction
  4. Nursing interventions
    1. Monitor for signs and symptoms of hypoxia including confusion, cyanosis, shortness of breath, tachycardia, and palpitations.
    2. Note that the presence of jaundice may make assessment of skin color in hypoxia unreliable.
    3. If jaundice and associated pruritus are present, avoid soap during bathing and use cool or tepid water.
    4. Frequent turning and meticulous skin care are important as skin friability is increased.
    5. Teach clients about the nature of the disease and identification of factors that predispose to episodes of hemolytic crisis.