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Hemolytic anemia associated with injection of fluorescein
Author(s) -
Munizza M.,
Kavitsky D.,
Schainker B.A.,
Poyser A.,
Peek C.,
Nance S.
Publication year - 1993
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1993.33893342754.x
Subject(s) - medicine , reticulocyte , fluorescein , hemoglobin , amoxicillin , anemia , antibody , vial , ingestion , chemistry , immunology , chromatography , antibiotics , biochemistry , fluorescence , physics , quantum mechanics , messenger rna , gene
A 49‐year‐old woman presented with a hemoglobin level of 9.5 g per dL (95 g/L), reticulocyte count of 6.7 percent (0.067), and hemoglobinuria. The next day, the hemoglobin had dropped to 5.8 g per dL (58 g/L), and total bilirubin was 8.8 mg per dL (150 μmol/L). The serum reacted 2+ with all red cells (RBCs). The direct antiglobulin test (DAT) was 3+ with anti‐IgG and 1+ with anti‐C3, but eluates prepared by two different methods did not react with untreated RBCs. The eluate reacted 2+ with amoxicillin‐coated RBCs; amoxicillin had been listed in the patient's record as a previous medication. The patient denied recent ingestion of amoxicillin. Further investigation documented the injection of a dye, fluorescein sodium (AK‐FLUOR‐25%), for a ophthalmologic fluorescein angiographic study 2 days before admission. RBCs coated with AK‐FLUOR reacted with the eluate. Controls consisting of normal serum, an eluate prepared from DAT‐negative RBCs, and a serum known to contain anti‐penicillin did not react with AK‐FLUOR‐coated RBCs. Nine days later, the DAT was negative and the serum did not react with untreated RBCs. In the presence of AK‐FLUOR (1‐in‐125) or amoxicillin (1 mg/mL), the serum reacted 2+ in the antiglobulin test. Antibodies to AK‐FLUOR and amoxicillin appeared to react by two mechanisms, which is similar to results in recent reports of other drugs associated with hemolytic anemia. AK‐FLUOR has not previously been reported to be associated with hemolytic anemia.