Acquired hemolytic anemia is a disorder that is developed later in life, in which red blood cells are destroyed faster than they can be made, also known as hemolysis.

Acquired hemolytic anemia is non-genetic in origin and may occur as the result of, or in conjunction with, some other medical condition, in which case it is “secondary” to another disorder. Rarely will it occur alone without a precipitating factor.

Acquired hemolytic anemia can be caused by several kinds of disorders and can be short-term or chronic. Causes of this condition include, but are not limited to:

• infections (viral or bacterial);

• blood cancers;

• tumors;

• an autoimmune response where the immune system destroys red blood cells;

• certain medications, such as antibiotics;

• abnormalities of the cell membrane, where the red blood cell may take on a different shape, other than the normal disc-shape;

• Hemoglobin disorders, such as sickle cell anemia (see Diagnostic Code: 7714 Sickle cell anemia) or one of the thalassemias;

• inherited enzyme deficiencies inside red blood cells that may cause the cells to become fragile; or

• unusual situations that may lead to the destruction of red blood cells (for example, blood transfusions or cells passing through oxygenating machines during open heart surgery may undergo changes that lead to this condition).

Symptoms of acquired hemolytic anemia resemble those of other anemias, and include, but are not limited to:

•  fatigue

• pale color

• dyspnea on exertion or at rest

•  palpitations

• dark urine; chills

• weakness

• confusion

•  backache

In severe cases, jaundice may be present, and the spleen may be enlarged.

Laboratory tests, such as a CBC or Coombs test, or urine tests, may be conducted. Bone marrow aspiration, and a biopsy may also be done.

When acquired hemolytic anemia is secondary to, or caused by another condition, it is best treated by first diagnosing and treating the underlying condition.

Oral steroids or intravenous hydrocortisone may be used to treat the condition. If the condition does not respond favorably to steroid treatment, other therapeutic approaches, such as use of immunosuppressive drugs, may be considered.

In severe cases, in which the condition is unresponsive to therapeutic approaches, removal of the spleen (splenectomy) or blood transfusions may be necessary.

Following a splenectomy, complications may include: bleeding, pneumonia, atelectasis, and an increased susceptibility to infection. Leukocytosis and thrombocytosis occur after the removal of the spleen, and may last for years. After a splenectomy, other structures, particularly the bone marrow and the liver, then assume the functions of the spleen.

• Consider service connection for primary anemia on a presumptive basis as a chronic condition (38 CFR 3.307; §3.309(a)).

• A 100 percent evaluation for bone marrow transplant shall be assigned as of the date of hospital admission and shall continue for six months after hospital discharge with a mandatory VA examination six months following hospital discharge. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e).

• Separately evaluate splenectomy under diagnostic code 7706 and combine with an evaluation under diagnostic code 7723.