Question

A 27 year old black male is going on a mission trip to Africa. His doctor prescribes prophylactic antimalarial medication. After taking the medication, he experiences an acute hemolytic episode with hemoglobinuria, back pain and chills. His CBC reveals a mild anemia with normal indices, normal wbc and normal platelet count. Review of the peripheral smear reveals a few spherocytes and odd red blood cells with peripheral areas having no hemoglobin.

What do you suspect is the cause of the hemolytic crisis?

How would you prove your suspicion?

Answer 1

• Hemolytic anemia is a condition when abnormal breakdown of red blood cells happens. G6DP are housekeeping enzyme which reduce the generation of GSH in the blood and prevent oxidation of the red blood cells.
• Antimalarial drugs like quinine, chloroquine and primaquine show hemolytic effect.
• Quinine induced hemolysis to form complex resistance component, in which the medicate actuates IgM counter acting agent generation. The drug-antibody complex will bind to the red blood cells layer and activate complement pathway, cause intravascular hemolysis.
• When patient medicate with antimalarial drug, it lower amount of RBCs due to hemolysis cause by drug-antibody complex. This increase the level of GSH in blood as well and lead to oxidation of red blood cells. This result of hemolytic anemia or crisis.