title: Hemolytic anemia associated with injection of fluorescein.
abstract: 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 mumol/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.
authors.affiliation: American Red Cross Blood Services, Penn-Jersey Region, and Frankford Hospital, Philadelphia, Pennsylvania.
authors.forename: M
authors.initials: M
authors.lastname: Munizza
authors.forename: D
authors.initials: D
authors.lastname: Kavitsky
authors.forename: B A
authors.initials: BA
authors.lastname: Schainker
authors.forename: A
authors.initials: A
authors.lastname: Poyser
authors.forename: C
authors.initials: C
authors.lastname: Peek
authors.forename: S
authors.initials: S
authors.lastname: Nance
mesh_terms: D000017:ABO Blood-Group System; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced*; D001788:Blood Grouping and Crossmatching; D003298:Coombs Test; D005260:Female; D019793:Fluorescein; D005451:Fluorescein Angiography / Q000009:adverse effects; D005452:Fluoresceins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged
chemical_list: D000017:ABO Blood-Group System; D005452:Fluoresceins; D019793:Fluorescein