Oxidant hemolysis
●Stanley Schrier, Stanford University Medical Center
The lefthand panel is a peripheral smear from a patient who developed a hemo-
lytic anemia while taking Pyridium (phenazopyridine). She was supposed to
take it for 3 days for bladder discomfort but continued taking it for almost a month.
Note the “bite cells,” which are abnormal red blood cells (RBCs) that look like a bite
has been taken out; other names are hemiblister or cross-linked cells. The drug causes
oxidant damage to the RBC membrane and hemoglobin, leading to accelerated
removal of the affected RBCs. The righthand panel is a positive Heinz-body prepara-
tion from the patient. The supravital stain of the peripheral blood with new methyl
violet detects oxidatively denatured hemoglobin. Splenic removal (pitting) of the dena-
tured hemoglobin may produce the “bites” seen in the first panel.
The above image was first published in the ASH IMAGE BANK, a reference and teaching tool that is
continually updated with new atlas images and images of case studies. For more information or to
contribute to the Image Bank, visit www.ashimagebank.org.
w
orkbloodIMAGES IN HEMATOLOGY
3083BLOOD, 1 NOVEMBER 2003 䡠VOLUME 102, NUMBER 9
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For personal use only.on October 18, 2016. by guest www.bloodjournal.orgFrom
