Arsine toxicity treated with red blood cell and plasma exchanges.
BACKGROUND
Acute toxicity due to inhalation of arsine gas (AsH(3)) has no known antidote. Exchange transfusion may be beneficial, and dialysis is often required because arsine may cause acute intravascular hemolysis and renal failure. A patient with arsine toxicity has recently been treated by both red blood cell exchange (RBC-E) and plasma exchange (PE) therapy and our experience is reported.


METHODS
A 46-year-old man was accidentally and unknowingly exposed to arsine gas while observing an industrial procedure. Within 6 hours he developed fatigue, nausea, vomiting, and tingling in his extremities and voided dark urine. He quickly developed renal failure secondary to acute arsine toxicity (arsenic level, 1250 microg/L). Laboratory findings were a hematocrit level of 24 percent; blood urea nitrogen and creatinine, 84 and 5.5 mg per dL, respectively; bilirubin, 9.1 mg per dL; indirect bilirubin, 6.8 mg per dL; haptoglobin, less than 6 (normal, 30-200); and lactic dehydrogenase, 10,413 units per L (normal, 265-580). An emergent 1-vol RBC-E transfusion by continuous-flow method revealed dramatic black, grossly hemolyzed plasma. After two additional RBC-E and two PE and daily hemodialysis, he completely recovered over the course of 1 month.


CONCLUSIONS
Patients with arsine toxicity resulting in intravascular hemolysis should receive RBC-E as soon as possible. In addition, PE may be beneficial in removing the components of RBC lysis and further reducing arsenic levels.
Danielson
Constance
C
Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Houseworth
Julie
J
Skipworth
Elaine
E
Smith
Daniel
D
McCarthy
Leo
L
Nanagas
Kristine
K
D058186:Acute Kidney Injury / Q000139:chemically induced; D000395:Air Pollutants, Occupational / Q000633:toxicity*; D001151:Arsenic / Q000633:toxicity*; D001663:Bilirubin / Q000097:blood; D001781:Blood Component Removal; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion; D005500:Follow-Up Studies; D006242:Haptoglobins / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010951:Plasma Exchange; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D000395:Air Pollutants, Occupational; D006242:Haptoglobins; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001151:Arsenic; D001663:Bilirubin