title: Acute hemolytic anemia with acanthocytosis associated with high-dose misoprostol for medical abortion.
abstract: We report a case of acute hemolytic anemia in a 21-year-old Nigerian woman after high-dose misoprostol (4 mg), used for medical abortion. The major causes of inherited or immune hemolytic anemia were excluded. The patient's peripheral blood smear showed acanthocytes and anisopoikilocytosis, which progressively disappeared in the days postingestion. We evaluated RBC features, and we observed reduced RBC Na+ and K+ content and abnormalities in membrane cation transport pathways and in Ca2+ activated K+ channel (Gardos channel), suggesting possible direct effects of misoprostol on RBCs. Although further studies need to be carried out, the present case suggests that high-dose misoprostol, a prostaglandin E1 analogue, severely affects RBC features and causes an acquired acute hemolytic anemia, which is self-limited when misoprostol is withdrawn.
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Internal Medicine, University of Verona, Verona, Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Filippini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Villa
authors.forename: Roberto
authors.initials: R
authors.lastname: Corrocher
authors.forename: Lucia
authors.initials: L
authors.lastname: De Franceschi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D000028:Abortion, Induced; D000050:Acanthocytes; D000208:Acute Disease; D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000175:diagnosis; D002819:Chorea / Q000139:chemically induced* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000009:adverse effects*; D011247:Pregnancy
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol