Clinical presentation and management of hemolytic anemias

The hallmark of hemolysis is shortened red blood cell survival in the peripheral blood. Hemolysis results in anemia only when bone marrow cannot keep up with the rate of red cell destruction. Even though anemia is very commonly observed in most cancer patients, hemolytic anemias are rather rare. Acute or chronic hemolysis, when present can impact on quality of life adversely, especially when bone marrow has limited compensation capacity. The underlying etiologies and pathophysiologies of the varying types of hemolytic anemias differ vastly, and there are numerous disorders causing red blood cell destruction that result in a similar clinical presentation. Careful review of the peripheral blood smear can provide invaluable information in diagnosing the underlying disorder. The majority of the nonhemolytic anemias have a chronic and stable course. In hemolytic disorders, however, the severity of the hemolysis can also create life-threatening emergencies. Management of hemolytic anemias depend on the diagnosis. Thus clinicians often face added pressure to determine the causative disorder rapidly so that timely interventions can be planned. Thus, even though they are not very common, hemolytic anemias remain a big challenge in the practice of hematology and oncology.