As explained in ‘basics about blood‘, the hemoglobin in the red blood cells carries oxygen from the lungs to the body cells. When there’s not enough hemoglobin, the body cells won’t get enough oxygen, which can lead to a wide range of consequences.

The severity of the anemia may vary a lot between patients. In some patients there will be only a minor hemolytic anemia because the body can compensate the high destruction of red blood cells by a higher production of red blood cells in the bone marrow. Patients with mild anemia adapt really well and sometimes show little symptoms. On the other hand, some patients will have a more severe hemolytic anemia that will lead to very pale skin, fatigue, apathy, shortness of breath, dizziness, …

How our body compensates…

Hemoglobin is very important for the transportation of oxygen from the lungs to the body tissues. Every decrease of Hb will thus lead to a lack of oxygen in the tissues, which can cause a range of clinical phenomenon. Luckily, our body is able to compensate the lack of Hb:

• The beat volume and beat frequency (heart rate) of the heart will increase, as will the breathing volume and breathing frequency. This will increase the quantity of blood being pumped to the tissues.
• Due to a complex mechanism (controlled by the substance 2,3 DPG), the hemoglobin will release the oxygen more easily to the the tissues.
• The EPO-concentration will increase, causing a higher production of young red blood cells (reticulocytes).
• To ensure the brain get enough oxygen, the blood flow will be reshuffled by having less blood going to the skin and more to the brain. This explains the pale skin color that occurs with patients having hemolytic anemia.

Due to these compensatory mechanisms, the patient does encounter very little burden when staying calm. However, when the need for oxygen increases (by doing sports,…), this won’t be enough and the patient can suffer from fatigue, apathy, weakness, shortness of breath, dizziness,…. Because of the compensatory mechanisms mentioned before, the patient can develop tachycardia, having a heart rate that exceeds the normal range. When the anemia is chronic, it can even lead to heart failure, heart murmurs, angina pectoris or heart rhythm disorders.

“The strange thing is that I can feel like I’m Superwoman for a long time. But somewhere along the line my body will stop me anyway”
Female, 40 years

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