Hemolytic anemia and methemoglobinemia in a preterm baby as a complication of antenatal intraamnial injection of toluidine blue.

A late preterm infant was born 4.5 h after intraamniotic injection of 90 mg of Toluidine blue to confirm premature rupture of membranes. Due to the fetal exposition to the dye, the entire body of the patient was blue stained and the baby suffered from methemoglobinemia, Heinz' body positive hemolytic anemia and hyperbilirubinaemia requiring exchange transfusion. These complications underline that antenatal exposition of toluidine blue may result in considerable postnatal infant morbidity. Therefore intraamniotic application of toluidine blue should be discouraged.

Cocaine induces a reversible stomatocytosis of red blood cells and increases blood viscosity.

Severe side effects of cocaine consumption are vasoocclusive events such as myocardial infarction and stroke. We have hypothesized that cocaine could affect red blood cells (RBCs) and alter the rheological behaviour of blood. Heparinized blood from healthy volunteers was incubated with a final hematocrit of 45% with increasing cocaine concentrations: 0, 10, 100, 1000, and 10'000 µmol/L plasma. Time dependence of the shape change was tested in phosphate buffered saline containing cocaine. RBCs were fixed in 1% glutaraldehyde for morphological analysis. Blood viscosity was measured with a Couette Viscometer (Contraves LS 30) at 37°C and a shear rate of 69.5 s⁻¹. RBC aggregation was assessed with a Myrenne aggregometer. Cocaine induced a dose-dependent stomatocytic shape transformation of RBCs, which was more pronounced in buffer than in plasma (plasma protein binding of the drug). Stomatocytosis occurs when a drug intercalates preferentially in the inner half of the membrane lipid bilayer. It was a time-dependent process with two components, an almost instant shape change occurring within 1 s, followed by a gradual further shape change during 10 min. Stomatocytosis was reversible by resuspension of the RBCs in cocaine-free buffer. This stomatocytic shape change increased whole blood viscosity at high shear rate from 5.69±0.31 mPa.s to 6.39±0.34 mPa.s for control and 10'000 µmol/L cocaine, respectively (p<0.01). RBC aggregation was not affected by the shape change. These effects occurred at a cocaine concentration, which is several-fold above those measured in vivo. Therefore, it is unlikely that hemorheological factors are involved in vascular events after cocaine consumption.

[Neonatal hemolytic anemia after intra-amniotic injection of methylene blue]. / Anémie hémolytique néonatale après injection intra-amniotique de bleu de méthylène.

The authors report two cases of neonatal hemolytic anemia without methemoglobinemia secondary to intraamniotic injection of 10 mg of methylene blue. Evolution was favourable without exchange transfusion. This emphasizes the importance of searching for a toxic origin in case of neonatal hemolytic anemia without apparent cause.

Spectrum of haemolytic anaemias in Punjab, North India.

Between July 1974 and June 1978 the diagnosis of haemolytic anaemia was made in 267 patients. Thalassaemia major was the leading cause (40-50%) every year except in 1977, when a sharp rise in drug induced haemolysis in G-6-PD deficient patients (61.3%) was encountered. This was possible due to an increase in incidence of vivax malaria and the use of anti-malarial drugs in that year. Abnormal haemoglobins were noted in 9.7% of the total number of patients. Hereditary spherocytosis, autoimmune haemolytic anaemias and paroxysmal nocturnal haemoglobinuria formed a minor cause. Others included copper sulphate poisoning, snake bite, hornet sting and Plasmodium falciparum infection.