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Haemolytic anaemia: when red cells are destroyed too early | CION Cancer Clinics
Haemolytic anaemia means your red blood cells are being destroyed faster than your bone marrow can replace them. The usual signs are tiredness, breathlessness, yellow eyes and dark urine. The cause may be inherited, such as G6PD deficiency, or acquired, such as an immune attack, malaria or a medicine. This page explains the symptoms, the causes, the report words and what the page cannot tell you. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
What is haemolytic anaemia, in plain words?
Haemolytic anaemia means your red blood cells are being broken down faster than your bone marrow can replace them. The result is a low haemoglobin, often with yellow eyes and dark urine, because the broken cells release a yellow pigment the liver has to clear.
How it differs from the common kind
Most low haemoglobin in India comes from too little iron, so the body cannot make enough red cells. Here the problem is the opposite end. The marrow is usually working hard, sometimes harder than normal, but the cells are lost early. That is why iron tablets alone rarely fix it, and why the cause has to be found.
Two broad groups
In some people the red cells are fragile from birth, because of a change in a gene passed down in the family. In others the cells are normal, but something outside them destroys them: the immune system, an infection such as malaria, a medicine, or a mechanical heart valve. The group you fall into shapes every decision that follows.
This page explains the patterns. It cannot tell you which cause applies to you. That needs a doctor, an examination and a set of blood tests read together.
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When this cannot wait until tomorrow
Go to the nearest emergency department today, or call 108, if urine suddenly turns dark like tea or cola, the eyes turn yellow within a day or two, or there is breathlessness at rest, chest pain, fainting or confusion. The same applies to a child who turns pale and drowsy after a fever, a new medicine or eating fava beans. Take every recent report and a list of medicines with you. Do not wait to see whether it settles.
Not sure whether this applies to you?
Ask an oncologistWhy it happens
What causes red cells to break down early?
Doctors sort the causes by whether the fault lies inside the red cell or outside it. These are the ones seen most often.
Inherited enzyme or shape problems
The cell is weak from birth. Episodes can be triggered by an infection, a medicine or a food, or the breakdown can run quietly all the time.
Examples
- G6PD deficiency
- Hereditary spherocytosis, where cells are round and fragile
- Sickle cell disease and thalassaemia
The immune system attacking red cells
Called autoimmune haemolytic anaemia. The body makes antibodies against its own red cells. It can appear on its own, or alongside lupus, some infections, or blood cancers such as chronic lymphocytic leukaemia and lymphoma.
Infections
Malaria lives inside red cells and bursts them, which makes it an important cause in Telangana and Andhra Pradesh. Some other infections damage red cells directly or trigger an immune attack on them.
Medicines, valves and toxins
Certain antibiotics and antimalarial medicines can trigger breakdown, especially with G6PD deficiency. Mechanical heart valves can damage cells as they pass. Rarely, a transfusion reaction or a poison is the cause.
Never stop a prescribed medicine on your own. Tell the doctor who prescribed it.What you notice
What are the symptoms of haemolytic anaemia?
The symptoms come from two things happening at once: too few red cells carrying oxygen, and a build-up of the yellow pigment, bilirubin, released when they break.
Signs of a low haemoglobin
Tiredness that sleep does not fix. Breathlessness on stairs. A fast or pounding heartbeat. Pale skin, pale lips or pale inner eyelids. Headaches and dizziness when standing up. In older people it can show up as chest pain on walking or new confusion.
Signs of red cells breaking
Yellow eyes or skin, called jaundice. Dark urine, especially in the morning or after an episode. A feeling of fullness or dragging under the left ribs, from an enlarged spleen, which is the organ that filters out damaged red cells. Over years, some people form gallstones and get pain on the right side after meals.
When it comes and goes
In G6PD deficiency the pattern is often sudden. Someone is well, then within a few days of an infection or a trigger they turn yellow, pass dark urine and feel very weak. In inherited shape problems the jaundice may be mild and lifelong, flaring with illness. None of these symptoms on its own proves haemolysis. Liver disease also causes yellow eyes.
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On your report
Which report words point to red cell breakdown?
- Reticulocyte count
- The number of young red cells just released from the marrow. It is usually raised, because the marrow is trying to keep up.
- Indirect (unconjugated) bilirubin
- The yellow pigment from broken red cells, before the liver has processed it. A rise suggests breakdown rather than a liver problem.
- LDH
- An enzyme released from damaged cells. Raised in haemolysis, but also in many other conditions, so it is never read alone.
- Haptoglobin
- A protein that mops up haemoglobin spilled from burst cells. It tends to be low when cells are breaking.
- Direct antiglobulin test (DAT or Coombs test)
- Checks whether antibodies are stuck to your red cells. Positive points towards an immune cause.
- Peripheral smear
- A drop of blood looked at under a microscope. The shape of the cells often gives the first clue to the cause.
The pathway
How is the cause worked out?
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Confirming the cells are being destroyed
A complete blood count with reticulocytes, bilirubin, LDH and haptoglobin. Reference ranges differ between laboratories, and a single result is read alongside your symptoms and repeat tests.
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A careful history
Recent fever or travel, every medicine and herbal product, any family member with jaundice, gallstones at a young age or a removed spleen. Bring the names of all tablets, including ones already finished.
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Looking at the cells themselves
A blood smear and the DAT. Depending on what they show, a malaria test, a G6PD test, haemoglobin testing for sickle cell or thalassaemia, or a test of red cell fragility may follow.
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Looking for something behind it
If the cause is immune, the team checks for linked conditions, sometimes with scans. Only a few people need a bone marrow test.
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A plan matched to the cause
Treatment depends entirely on the cause. It can mean treating an infection, removing a trigger under medical advice, steroids, a transfusion, or occasionally surgery on the spleen.
Commonly believed
What do families often get wrong about it?
"Yellow eyes always mean jaundice from the liver."
Yellow eyes can come from the liver or from red cells breaking down. The blood tests look different in each. Treating it as a liver problem with home remedies can delay finding the real cause.
"More iron tablets will bring the haemoglobin up."
Iron is lost only when blood leaves the body. In haemolysis the iron usually stays inside, so extra iron rarely helps and can build up. Take iron only if a test shows you are short of it.
"If it is inherited, nothing can be done."
Many inherited types are managed well for life. Knowing the diagnosis tells you which infections, medicines and foods to watch for, and when to seek help early. It also helps other family members get tested.
"It means blood cancer."
Most haemolytic anaemia is not caused by cancer. A small share of immune cases are linked to a blood cancer, which is why a haematologist looks for one. A normal search is reassuring, not a sign something was missed.
Questions we are asked
Common questions about haemolytic anaemia
Is haemolytic anaemia serious?
It can be mild and steady for years, or it can drop the haemoglobin quickly over a few days. How serious it is depends on the cause, the speed of the fall and your heart and lungs. A sudden episode with dark urine and breathlessness needs same-day care. A mild, stable form usually needs regular review.
Why is my urine dark if my liver is normal?
When red cells burst inside blood vessels, the haemoglobin they spill passes into the urine and colours it like tea or cola. This is different from liver jaundice. It is a sign that breakdown is happening fast, so tell a doctor the same day and keep a note of when it started.
Can haemolytic anaemia go away?
Often yes, when the cause is temporary. Breakdown from an infection or a medicine usually settles once that is dealt with. Immune types may settle with treatment but can return. Inherited types are lifelong, though many people live with them well. Your haematologist can tell you which pattern fits your case.
Will I need a blood transfusion?
Not always. A transfusion is considered when the haemoglobin falls quickly, or when symptoms such as breathlessness or chest pain make it unsafe to wait. In immune types, matching blood takes longer and needs a careful laboratory. The decision is made by your treating team on your symptoms, not on one number.
Is it passed on to my children?
Only the inherited types are. G6PD deficiency, spherocytosis, sickle cell disease and thalassaemia can run in families, each in its own pattern. Immune, infection-related and medicine-related types are not inherited. If an inherited cause is found, ask whether brothers, sisters and children should be tested too.
What should I eat, and what should I avoid?
A normal balanced diet with plenty of green vegetables, pulses and fruit supports new red cell production. There is no special diet for most types. The exception is G6PD deficiency, where fava beans and some medicines must be avoided. Ask before taking any supplement, iron included.
Can a child have haemolytic anaemia?
Yes. Inherited types often show up in childhood, sometimes as jaundice in a newborn that lasts longer than expected, or as paleness and yellow eyes after a fever. A child who turns suddenly pale, drowsy or breathless needs emergency care. Mention any family history of jaundice or gallstones to the paediatrician.
Can CION help find the cause?
Yes. CION's haematology team reviews your reports, examines you and arranges the tests needed to find the cause. Complex cases are discussed at a tumour board, and specialised tests are coordinated with qualified laboratories. Ask which tests are planned, why each one is needed, and when you will hear back.
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Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Haemolytic anaemia
- NHS — G6PD deficiency
- NHS — Sickle cell disease
- WHO — Malaria fact sheet
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
G6PD Deficiency and Foods and Drugs to AvoidThe commonest inherited trigger of sudden red cell breakdownWhich Tests Find the Cause of AnaemiaWhat each test on the panel is looking forAnaemia That Does Not Improve With IronWhy iron tablets sometimes are not the answerWhen Anaemia Needs a HaematologistSigns that a specialist review is due
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Have a blood report that mentions haemolysis?
Share it with us or call the helpline. CION's haematology team will review it and tell you which tests come next. One helpline serves every CION centre.