Hemolytic anemia, treatment of anemia, and influence on driving
It is caused by intrinsic defects of red blood cells, or extrinsic to the red blood cell such as hypersplenism, immune disorders, mechanical damage from injuries or from the toxins of some infections.
The symptoms are similar to those seen in other types of anemia.
A fast hematocrit reduction leads to the sudden onset of a clinical condition including asthenia, tachycardia, lightheadedness, sweating, and dyspnea on effort, with fainting in some cases.
The gradual development of anemia can be associated with only growing tiredness and reduction of the tolerance to exercise.
- Hemolysis can be acute, chronic, or episodic, and serious acute hemolytic crisis is uncommon and associated with fever, abdominal pain, backache, shivering, and shock.
- Chronic hemolytic conditions can worsen in case of transient failure of production of red blood cells, most often related to an infection, frequently viral.
Hypersplenism is characterized by splenomegaly causing peripheral cytopenia and compensating bone marrow hyperplasia. It is frequently associated with leukopenia and thrombocytopenia. The degree of anemia is usually related to the size of the spleen.
Advice on with Hemolytic anemia
- Serious acute hemolytic crisis disables for driving until it subsides completely.
- Patients with chronic mild hemolytic episodes should know that, in the event of any condition that destabilizes them, even if a cold, can worsen their anemia and in these situations they will be recommended to ask their physician about the possible increased risk for driving.
- Drowsiness, loss of attention and some lightheadedness in moderate or severe cases of anemia with Hb < 8-10 g/dL can cause the loss of control of the car, so driving is not recommended in these cases.
- The physician will inform the patient in subsequent revisions, if the treatment established has stabilized anemia and controlled its cause, permitting driving.
- The physician will advise against driving in any anemia causing lightheadedness, drowsiness, and lack of attention.
- The physician will also assess the clinical signs and symptoms of the associated infectious, immunological, traumatic disease, etc, and will recommend, depending on the evolution of the patient, if he can drive.
- Large splenomegaly involves an added risk in the event of any impact, due to the possible rupture of the spleen, and to the massive abdominal hemorrhage.
- Leukopenia and thrombocytopenia sometimes associated with each other enhance infections and bleeding preventing from driving as long as they persist.
Some antifolate drugs cause macrocytic anemia as is the case of methotrexate, trimetroprim and hydroxyurea.
Other drugs induce hemolytic anemia, such as alpha-methyldopa, procainamide, penicillin, and cephalosporins.
Drug-induced anemia usually subsided with drug discontinuation.
Advice on Drug-induced anemia
- It is advised against driving as long the as the hemolytic episode secondary to a drug persists.
- The physician will inform on the stabilization of the patient after discontinuing or switching the drug, and when driving can be restarted.
General treatment of anemia
In deficiency states, the deficient substance is supplied as iron, vitamin B12, or folic acid.
In anemia of hemorrhagic origin it is essential to diagnose the bleeding organ and to carry out hemostasis.
Arregenerative anemia such as marrow aplasia can respond well to the administration of androgens, steroids, serum antithymocyte globulin (ATG), or bone marrow transplant.
Many hypersplenisms are cured with splenectomy.
The treatment of the associated chronic diseases and the prevention of the complications related with them will enable to improve the outcome of anemia.
Advice on General treatment of anemia
- During the treatment of anemia, the patient can drive if he is asymptomatic and without interactions added by the therapy prescribed.
- The patient susceptible to anemia should know that if he notes lightheadedness, loss of attention or of concentration when driving, he should park the car, ask for help and notify his physician as soon as possible.
- The physician will establish the appropriate treatment, and will inform when the patient is recovered and without symptoms interfering with driving.
- Anemia of sudden and progressive onset in a short time disables for driving for its symptoms and for the risk of losing control of the car at any time.
- It is advised against driving until the causal diagnosis is clarified and the treatment has controlled adequately the anemia.
- Splenectomy requires a postoperative recovery period without driving, until the specialist physician reports on the complete recovery of the patient, both from an hematological standpoint and with regard to wound healing.