About Paroxysmal Nocturnal Hemoglobinuria
Paroxysmal Nocturnal Hemoglobinuria results from acquired somatic mutations in the PIGA gene, which encodes a protein essential for biosynthesis of glycosylphosphatidylinositol (GPI) anchors. These anchors normally attach proteins that protect blood cells from complement-mediated destruction. Loss of GPI anchors leaves red blood cells, white blood cells, and platelets vulnerable to complement-mediated lysis.
Hemolysis can be intravascular (within blood vessels) or extravascular (in spleen), leading to hemolytic anemia. Dark urine (hemoglobinuria) occurs from hemoglobin excretion in urine. A major complication is thrombosis (blood clots) due to complement activation, endothelial damage, and platelet activation, with venous thrombosis being most common (portal vein, hepatic vein, deep veins, cerebral veins).
Thrombotic events can be life-threatening. Smooth muscle dystonia (involuntary smooth muscle contraction) can cause severe abdominal pain, urinary symptoms, and erectile dysfunction. Chronic hemolysis causes iron loss and secondary effects. Patients may develop aplastic anemia or myelodysplastic syndrome as complications.
Common Symptoms of Paroxysmal Nocturnal Hemoglobinuria
Recognizing the signs of Paroxysmal Nocturnal Hemoglobinuria early can lead to faster diagnosis and better outcomes. Symptoms may vary in severity from person to person. If you or a loved one are experiencing any of the following, consider speaking with a specialist.
- Hemoglobinuria (dark red or brown urine, especially after sleep)
- Fatigue and weakness from hemolytic anemia
- Shortness of breath and chest discomfort
- Back pain, abdominal pain, or leg pain (from thrombosis)
- Headaches and neurologic symptoms
- Smooth muscle dystonia causing abdominal or urinary symptoms
Who Paroxysmal Nocturnal Hemoglobinuria Affects
Paroxysmal Nocturnal Hemoglobinuria can develop at any age, from childhood to elderly, with median age of diagnosis around 35-40 years. It affects males and females equally. The disease occurs across all racial and ethnic groups.
It is acquired somatically and not inherited, resulting from a single PIG-A gene mutation in a hematopoietic stem cell that then expands clonally. About 10-25% of PNH patients have concurrent myelodysplastic syndrome or aplastic anemia.
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FDA-Approved Treatments for Paroxysmal Nocturnal Hemoglobinuria
There are currently 3 FDA-approved medications for Paroxysmal Nocturnal Hemoglobinuria. These therapies represent the current standard of care and may be used alongside or compared against investigational treatments in active clinical trials.
Source: openFDA drug labeling data. This list may not include all treatments. Always consult your doctor.
Help Paying for Paroxysmal Nocturnal Hemoglobinuria Treatment
Charity funds and drugmaker programs for Paroxysmal Nocturnal Hemoglobinuria, checked at the source. Pick your insurance to see what fits.
- From a charity · NORD RareCarePNH Medical Assistance fundOpen
Pays for: Medical and medication costs.
The foundation says: “Accepting new applications and re-enrollments for current year” - From a charity · NORD RareCarePNH Premium Copay Assistance fundOpen
Pays for: Insurance premiums and copays.
The foundation says: “Accepting new applications and re-enrollments for current year” - From a charity · The Assistance FundParoxysmal Nocturnal Hemoglobinuria (PNH) fundOpen
Pays for: Copays, coinsurance, deductibles and other health-related expenses.
The foundation says: “OPEN — Accepting New Patients. TAF is currently accepting new patient enrollments for this program.” - From a charity · TotalAssist (formerly PAN Foundation)Paroxysmal Nocturnal Hemoglobinuria fundOpen
Pays for: Out-of-pocket costs for approved medications, up to $9,500 per year. Requires health insurance (any kind).
- From a charity · Aplastic Anemia & MDS International FoundationPNH Patient Travel Assistance Fund fundApply directly
Pays for: Travel to a PNH specialist or second opinion (patient plus one companion), up to $800 per year.
The foundation says: “Status not shown on page”
- Piasky (Crovalimab) · PiaSky Access Solutions
- Voydeya (Danicopan) · Alexion OneSource
- Fabhalta (Iptacopan) · Novartis Patient Support
Side Effect Explorer
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Genetic Testing
Genetic testing can confirm a diagnosis, guide treatment decisions, and identify family members who may be at risk.
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Trusted Paroxysmal Nocturnal Hemoglobinuria Resources
Reputable organizations and medical references for learning more about Paroxysmal Nocturnal Hemoglobinuria, including disease registries, foundation resources, and clinical guidelines.