Red cell walls can be destroyed by a misdirected immunologic process, by unusually rigid red cells, by an unusual response to a drug, or by bashing against artificial heart valves. Sometimes this can be associated with jaundice and an enlarged spleen. The clue here is a positive test for antibody on the surface of red cells - a positive Coomb's test. This test might be done when small round red cells or blue tinged red blood cells appear in the blood smear. This requires a bone marrow examination from the crest of the hip bone using local anesthesia.
Cells containing abnormal hemoglobin live less long than normal ones.
A trait from both parents will lead to the disease. Rigid sickle cells block capillaries and cause acutely painful crisis. Finally the bone marrow red cell production factory can shut down, perhaps after a drug insult such as gold salts or chloromycetin or a job related poison like benzene. If the entire bone marrow becomes empty, it is called aplastic or no growth anemia. Young red cells are looked for to judge the response to treatment in any of these anemias.