Monitoring can help you keep tabs on hemolysis and
low hemoglobin

Icon blood vial with a red check mark next to it

There are a few ways to directly and indirectly monitor hemolysis and hemoglobin

Levels can be checked by your healthcare provider with a simple blood draw.

Bilirubin

Bilirubin is created when red blood cells break down early as part of hemolysis.

Reticulocytes

Reticulocytes are immature red blood cells that are made in the bone marrow. After being released into the bloodstream, reticulocytes mature into red blood cells.

Hemoglobin (Hb)

Hb levels are checked to monitor for anemia.

  • Bilirubin is also responsible for yellowing of the skin and white of the eyes. This is known as jaundice
  • High bilirubin signals that hemolysis is occurring
  • Normal bilirubin levels are between 0.1 and 1.2 milligrams per deciliter (mg/dL), while levels seen with hemolysis are typically 2 to 3 mg/dL
  • When too many red blood cells are breaking down early (hemolysis), the body tries to replace them. This increases the amount of reticulocytes
  • This is a signal that the bone marrow is making new red blood cells to replace those lost from hemolysis
  • Normally, the % of cells that are reticulocytes versus mature red blood cells range between 0.5% and 2.5%. With hemolysis, the % is usually above 2.5%
  • Healthy Hb levels in adults without sickle cell disease:
    • Males: 14-17 grams per deciliter (g/dL)
    • Females: 12-15 g/dL
  • Hb levels are lower in those with sickle cell disease, at around 6-11 g/dL
    • Low or decreasing Hb levels are associated with hemolytic anemia

Bilirubin

Bilirubin is created when red blood cells break down early as part of hemolysis.

  • Bilirubin is also responsible for yellowing of the skin and white of the eyes. This is known as jaundice
  • High bilirubin signals that hemolysis is occurring
  • Normal bilirubin levels are between 0.1 and 1.2 milligrams per deciliter (mg/dL), while levels seen with hemolysis are typically 2 to 3 mg/dL

Reticulocytes

Reticulocytes are immature red blood cells that are made in the bone marrow. After being released into the bloodstream, reticulocytes mature into red blood cells.

  • When too many red blood cells are breaking down early (hemolysis), the body tries to replace them. This increases the amount of reticulocytes
  • This is a signal that the bone marrow is making new red blood cells to replace those lost from hemolysis
  • Normally, the % of cells that are reticulocytes versus mature red blood cells range between 0.5% and 2.5%. With hemolysis, the % is usually above 2.5%

Hemoglobin (Hb)

Hb levels are checked to monitor for anemia.

  • Healthy Hb levels in adults without sickle cell disease:
    • Males: 14-17 grams per deciliter (g/dL)
    • Females: 12-15 g/dL
  • Hb levels are lower in those with sickle cell disease, at around 6-11 g/dL
    • Low or decreasing Hb levels are associated with hemolytic anemia

Your doctor will keep an eye on your bilirubin, reticulocytes, and Hb and watch for changes

This can help your doctor understand how much strain sickle cell disease is putting on your body over time. Talk to your healthcare team if:

  • Your symptoms suddenly change
  • You feel even more tired than usual
  • You notice new or worsening yellowing of your skin or eyes

Work with your doctor to monitor hemolysis and hemoglobin and establish appropriate levels based on your own individual needs.