What can destroy blood cells? Exploring the causes of hemolysis

October 1, 2025 •

5 min read

Every second, your body produces millions of blood cells to replace aging ones, but sometimes this natural process is disrupted. A variety of conditions, medications, and external factors can accelerate this destruction, answering the question: what can destroy blood cells? This premature breakdown, known as hemolysis, can have significant health consequences.

Quick Summary

Premature blood cell destruction, or hemolysis, is triggered by a range of factors, including inherited genetic conditions like sickle cell anemia, autoimmune disorders where the body attacks its own cells, certain infections such as malaria, specific medications, exposure to toxins, and complications from medical procedures or devices.

Key Points

Genetic Causes: Inherited conditions like sickle cell disease and thalassemia cause structural and functional defects in red blood cells, leading to their premature destruction.
Immune System Attacks: In autoimmune hemolytic anemia, the body's immune system wrongly identifies red blood cells as threats and produces antibodies to destroy them.
Infections and Toxins: Infections from pathogens like malaria, and exposure to environmental toxins such as lead or arsenic, can directly damage and burst red blood cells.
Medication and Devices: Certain medications (including some antibiotics) and medical devices like artificial heart valves can trigger hemolysis through immune reactions or mechanical trauma.
The Spleen's Role: The spleen is the primary site of extravascular hemolysis, filtering and destroying damaged blood cells. When overactive, it can contribute significantly to anemia.
Hemolytic Anemia: When blood cells are destroyed faster than the bone marrow can replace them, it results in hemolytic anemia, causing symptoms like fatigue and jaundice.

What is Hemolysis?

Hemolysis is the medical term for the premature destruction of red blood cells (RBCs). While the body naturally removes old or damaged red blood cells after their normal lifespan of about 120 days, hemolysis occurs when this destruction happens too early and too rapidly. This leads to a shortage of healthy red blood cells, a condition known as hemolytic anemia, which can cause symptoms like fatigue, paleness, and jaundice. The process can be classified into two main types: intravascular hemolysis, which happens within the blood vessels, and extravascular hemolysis, which occurs outside the vessels, often in the spleen or liver.

Inherited Conditions That Destroy Blood Cells

Certain genetic disorders alter the structure or function of red blood cells, making them fragile and prone to early destruction. These conditions are passed down from parents and affect the blood cells from birth.

Hemoglobinopathies

These disorders affect the hemoglobin protein inside red blood cells, which is responsible for carrying oxygen. The abnormal hemoglobin can cause the cells to lose their normal shape and be destroyed more easily by the body.

Sickle Cell Disease: This is a group of inherited blood disorders characterized by crescent-shaped red blood cells. These abnormal cells are rigid, can block small blood vessels, and are more easily destroyed by the spleen, leading to chronic anemia and pain.
Thalassemias: These are inherited blood disorders that cause the body to have less hemoglobin than normal. The resulting red blood cells are unstable and have a shorter lifespan, leading to anemia.

Red Blood Cell Membrane Defects

These conditions involve structural problems with the red blood cell membrane, making the cells fragile and misshapen.

Hereditary Spherocytosis: A defect in the proteins of the cell membrane causes red blood cells to become spherical instead of their usual biconcave disc shape. The spleen recognizes these misshapen cells as defective and prematurely destroys them.

Enzyme Deficiencies

Enzymes are essential for red blood cell function. Deficiencies can make the cells vulnerable to oxidative damage and early breakdown.

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: This is an inherited condition that can cause red blood cells to break down in response to certain triggers, such as infections, some medications, or fava beans.

External and Acquired Causes of Hemolysis

Unlike inherited conditions, these factors affect otherwise healthy red blood cells and are not present from birth. They can range from immune system issues to environmental exposures.

Autoimmune Hemolytic Anemia (AIHA)

In AIHA, the immune system mistakenly identifies red blood cells as foreign invaders and creates antibodies to attack and destroy them. This can occur on its own (idiopathic) or secondary to another illness, such as lupus, lymphoma, or viral infections. AIHA is classified as either 'warm' or 'cold' depending on the temperature at which the antibodies are most active.

Infections

Several infectious agents, including parasites, bacteria, and viruses, can damage or destroy red blood cells as part of their lifecycle or due to the body's immune response.

Malaria: Caused by a parasite, malaria is a well-known infectious cause of hemolysis, as the parasites multiply inside and eventually burst the red blood cells.
Other Infections: Viruses like HIV and certain bacterial infections can also trigger red blood cell destruction.

Medications and Toxins

A number of external substances can damage blood cells, sometimes causing drug-induced immune hemolytic anemia (DIHA) where the immune system reacts to the drug and attacks the red blood cells.

Medicines: Common culprits include certain antibiotics (e.g., penicillin and cephalosporins), some NSAIDs, and anti-malarial drugs.
Toxins: Exposure to poisons such as lead, copper, or arsenic, and certain snake venoms can cause direct damage to red blood cells.

Mechanical Damage

In some cases, physical trauma can cause red blood cells to rupture.

Artificial Heart Valves: Red blood cells can be sheared and damaged as they pass through faulty or artificial heart valves.
Other Devices: Medical treatments like hemodialysis or extracorporeal membrane oxygenation (ECMO) can also cause mechanical damage.

Comparison of Hemolysis Causes


Cause Category	Example Conditions	Mechanism of Destruction	Onset	Typical Treatment
Inherited	Sickle Cell Anemia, Thalassemia, Hereditary Spherocytosis	Defective cell structure or hemoglobin leads to fragility and early removal by spleen.	Congenital (from birth)	Symptom management, medications, sometimes splenectomy.
Autoimmune	Warm or Cold AIHA, Lupus, Lymphoma	Immune system produces antibodies that attack red blood cells.	Can be sudden or gradual, secondary to other disease.	Steroids, other immunosuppressants, transfusions.
Infectious	Malaria, HIV, Certain Bacteria	Pathogens directly damage red blood cells or trigger an immune response.	Acute, often coinciding with infection.	Treating the underlying infection.
Drug-Induced	Certain Antibiotics, NSAIDs	Drug triggers an immune response against red blood cells.	Acute, after starting medication.	Discontinuing the offending drug.
Toxic Exposure	Lead, Copper, Snake Venom	Chemical compounds directly damage red blood cell membranes.	Acute, after exposure.	Removing the source of the toxin, supportive care.
Mechanical	Artificial Heart Valves	Physical force shears and fragments red blood cells.	Can be acute or chronic, after medical procedure.	Addressing the underlying device issue.

The Spleen's Role in Blood Cell Destruction

The spleen is a major organ responsible for filtering blood and removing old, damaged, or misshapen red blood cells. When red blood cells are defective or coated with antibodies (as in AIHA), the spleen's filtering process can become overactive, destroying the blood cells at a faster rate than the body can produce new ones. This is a key mechanism in extravascular hemolysis. In some severe cases, a splenectomy (surgical removal of the spleen) may be performed to stop this excessive destruction when other treatments fail.

Conclusion: Understanding the Full Picture

Numerous factors, from inherited defects to external influences, can destroy blood cells. The process, known as hemolysis, can lead to hemolytic anemia if the rate of destruction exceeds the body's ability to replace them. It is crucial to understand the diverse causes, as the correct diagnosis is the first step toward effective treatment. Whether the cause is a genetic abnormality, an immune system malfunction, or an environmental factor, identifying the root issue is essential for managing the condition and alleviating its symptoms.

For more detailed information on hemolytic anemia and its causes, the National Institutes of Health provides comprehensive resources on blood disorders and treatments, which can be found at https://www.nhlbi.nih.gov/health/anemia/hemolytic-anemia.

Frequently Asked Questions

Inherited causes of hemolysis are genetic defects passed down from parents that result in structurally or functionally abnormal blood cells from birth. Acquired causes, on the other hand, affect otherwise normal blood cells due to external factors like infections, medications, or autoimmune reactions after birth.

Yes, in rare cases of intense, prolonged physical exercise, a condition known as 'march hemoglobinuria' can occur. It involves the mechanical rupture of red blood cells, particularly in the feet, leading to a temporary increase in blood cell destruction.

Malaria parasites infect and multiply inside red blood cells. As the parasites mature, they cause the blood cells to burst, releasing new parasites and leading to massive blood cell destruction and the characteristic fever and chills associated with the disease.

Symptoms of accelerated blood cell destruction often relate to anemia and may include fatigue, weakness, dizziness, paleness, and shortness of breath. Jaundice (yellowing of the skin and eyes) and an enlarged spleen are also common indicators.

Yes, an incompatible blood transfusion can cause a severe immune reaction where the recipient's antibodies attack the donor's red blood cells, leading to a rapid and life-threatening hemolytic reaction.

Certain medications can induce immune hemolytic anemia (DIHA) by triggering the immune system to produce antibodies that destroy red blood cells. The hemolysis usually resolves after stopping the medication.

While an overactive spleen (hypersplenism) is a common cause of premature blood cell destruction, an enlarged spleen can be caused by various conditions and does not automatically indicate hemolysis. However, it is a key symptom that warrants further investigation.