Hemolytic anemias are red blood cell deficiencies caused by the premature destruction of these cells in the circulation. The normal circulatory lifespan of a red blood cell is approximately 120 days. Premature hemolysis--the term for red blood cell destruction--that outpaces bone marrow production leads to anemia. Hemolytic anemias are divided into autoimmune and non-autoimmune varieties. The symptoms of both varieties of hemolytic anemia prove indistinguishable. Diagnostic testing differentiates among the many causes of hemolytic anemia.
Dark Urine and Jaundice
The hemolysis of red blood cells liberates the chemical bilirubin, a byproduct of hemoglobin breakdown. Liver cells absorb and process bilirubin, incorporating the chemical into bile, which is excreted into the small intestine. Hemolytic anemias can overwhelm the liver's capacity to process bilirubin, causing an accumulation of the chemical in the bloodstream.
Bilirubin is a vivid yellow color, which causes yellow discoloration of the skin, moist membranes, whites of the eyes and nail beds when present in high concentrations, according to the University of Maryland Medical Center. This condition, known as jaundice, is an important finding in distinguishing hemolytic from nonhemolytic anemias. With an elevated blood bilirubin, some of the chemical appears in the urine. The chemicals of the urine react with bilirubin, causing urine to appear tannish-yellow to brown.
Upper Abdominal Pain
Along with the liver, the spleen serves as a primary site for removal of red blood cells from the circulation. The increased rate of red blood cell removal and destruction associated with hemolytic anemias may cause enlargement of the spleen, with accompanying upper abdominal pain, says the National Heart, Lung and Blood Institute.
The gallbladder is a second source of abdominal pain associated with hemolytic anemias. A chronically elevated bilirubin level may lead to the formation of bilirubin-based gallstones, which can provoke gallbladder attacks with upper right abdominal pain.
Paleness
The red blood cells flowing in minute blood vessels impart the skin and moist tissues of the body with a pinkish-red tone. A decreased number of circulating red blood cells causes a characteristic paleness, or pallor, according to the Merck Manual for Healthcare Professionals. The lining of the eyelids and mouth, the lips and the nail beds manifest the pallor of anemia.
Fatigue and Poor Exercise Tolerance
The red blood cells carry oxygen to the body tissues. A steady supply of oxygen is necessary for cells to efficiently generate the energy needed for normal metabolism, according to the National Heart, Lung and Blood Institute. In the absence of sufficient oxygen, the body tissues resort to less-efficient mechanisms to generate energy. Thus, a significant anemia provokes a persistent sense of fatigue due to inefficient cellular metabolism. Similarly, the body performs suboptimally with physical exertion due to the decreased oxygen-carrying capacity that exists in an anemic state. People with anemia typically tire easily and become winded quickly with physical exertion.
