Liver involvement in hemolytic anemias

Hemolytic anemias in childhood comprise a heterogeneous group of hereditary and acquired diseases that may be associated with liver involvement through multiple mechanisms. Chronic hemolysis leads to a sustained increase in unconjugated bilirubin, with a risk of pigmentary cholelithiasis; ineffective erythropoiesis and repeated transfusions contribute to iron overload and the development of chronic liver disease. In certain conditions, such as sickle cell anemia, vaso-occlusive events can cause acute and chronic liver damage. Furthermore, there are well-documented associations between autoimmune hemolytic anemias and immune-mediated liver diseases. This review analyzes the main types of hemolytic anemia associated with liver disease in children, including thalassemias, hereditary spherocytosis and elliptocytosis, sickle cell anemia, pyruvate kinase deficiency, and autoimmune hemolytic anemias. The review describes pathophysiological mechanisms, clinical and biochemical manifestations, diagnosis, treatment, and follow-up. Early recognition of liver involvement allows for optimized treatment and the prevention of potentially serious complications.