溶血性贫血的流行病学机制随基础病因而变。例如,葡萄糖-6-磷酸脱氢酶缺乏症是一种伴 X 染色体的酶代谢缺陷,可导致患者在患病或用某种药物后发生溶血。它是最早记载、最为常见的红细胞酶缺乏症,可导致红细胞寿命缩短。其患病率范围较大,从库尔德犹太人的 50% 到北欧人的 < 1:1000。[1]Beutler E. Red cell enzyme defects. Hematol Pathol. 1990;4:103-114.http://www.ncbi.nlm.nih.gov/pubmed/2258359?tool=bestpractice.com在中国和东南亚人中都有发现,但在日本比较罕见。此种红细胞酶缺乏症在西非相当普遍,此地区黑人男性的患病率为 11%。[2]Heller P, Best WR, Nelson RB, et al. Clinical implications of sickle-cell trait and glucose-6-phosphate dehydrogenase deficiency in hospitalized black male patients. N Engl J Med. 1979;300:1001-1005.http://www.ncbi.nlm.nih.gov/pubmed/431593?tool=bestpractice.com黑人女性的患病率 < 10%,地中海盆地的人群患病率较低。[3]Prchal JT, Gregg XT. Red cell enzymes. Hematology Am Soc Hematol Educ Program. 2005:19-23.http://asheducationbook.hematologylibrary.org/cgi/content/full/2005/1/19http://www.ncbi.nlm.nih.gov/pubmed/16304354?tool=bestpractice.com
温抗体型溶血性贫血是一种自身免疫性病因导致的最常见的溶血性贫血,受影响的女性多于男性。它可能自发性或与系统性红斑狼疮 (SLE)、淋巴瘤或慢性淋巴细胞白血病等疾病相关。[4]Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am J Hematol. 2002;69:258-271.http://onlinelibrary.wiley.com/doi/10.1002/ajh.10062/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/11921020?tool=bestpractice.com[5]Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood. 2017;129:2971-2979.http://www.ncbi.nlm.nih.gov/pubmed/28360039?tool=bestpractice.com据报告,药物也是溶血性贫血的病因,但比较罕见,估计发病率为一百万分之一。[6]Garratty G. Drug-induced immune hemolytic anemia. Hematology Am Soc Hematol Educ Program. 2009:73-79.http://asheducationbook.hematologylibrary.org/cgi/content/full/2009/1/73http://www.ncbi.nlm.nih.gov/pubmed/20008184?tool=bestpractice.com