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The New England Journal of MedicineDrug-Induced Oxidative Hemolysis

Unraveling the Perils: Drug-Induced Oxidative Hemolysis and Its Clinical Ramifications

A case study illuminates the perilous consequences of drug-induced oxidative hemolysis, underscoring the vital importance of vigilance in patient history-taking and toxicological investigation to uncover potentially life-threatening causes of anemia.

Key Points:

  • A 57-year-old woman presented with shortness of breath and dizziness, revealing a hemoglobin level of 4.4 g/dL, elevated reticulocyte count, and low haptoglobin level.
  • Laboratory findings indicated oxidative hemolysis, characterized by poikilocytosis, nucleated red cells, and polychromatic cells on peripheral-blood smear.
  • Heinz bodies, identified via positive staining with methyl violet, confirmed the presence of drug-induced oxidative hemolysis after toxicologic investigation.
  • The patient admitted to excessive zopiclone use, 10 times the recommended daily dose, to treat insomnia, leading to the diagnosis.
  • Urgent blood transfusions were administered, followed by cessation of zopiclone use and psychiatric referral.
  • The case underscores the importance of thorough medication history-taking and toxicological screening in unexplained cases of anemia, especially in patients with risk factors for drug-induced hemolysis.

Drug-induced immune haemolytic anaemia (DIHA) is a rare complication of drug treatment and has an estimated incidence of approximately 1-4 cases per million individuals per year.

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