J Korean Med Sci.  2004 Feb;19(1):127-129. 10.3346/jkms.2004.19.1.127.

Hemolytic Anemia as a Sequela of Arsenic Intoxication Following Long-Term Ingestion of Traditional Chinese Medicine

• Lee JJ
• Kim YK
• Cho SH
• Park KS
• Chung IJ
• Cho D
• Ryang DW
• Kim HJ

• KMID: 1785706
• DOI: http://doi.org/10.3346/jkms.2004.19.1.127

Abstract

We report on a 51-yr-old woman who developed intravascular hemolytic anemia caused by arsenic after long-term ingestion of a traditional Chinese medicine (TCM). Twelve years before the admission, she was diagnosed as neurocysticercosis. She has ingested a TCM for about 12 yr instead of undergoing medical therapy for the disease. She was presented with a severe Coombs'-negative hemolytic anemia with hemosiderinuria. The urine arsenic level was elevated suggesting the arsenic intoxication as a cause of the anemia. She was treated successfully with therapeutic red cell exchange without any sequelae.

Keyword

Anemia, Hemolytic; Arsenic; Medicine, Traditional Chinese

MeSH Terms

Anemia, Hemolytic/*diagnosis
Arsenic/*toxicity/urine
*Arsenic Poisoning
Erythrocytes/*cytology
Female
Human
Medicine, Chinese Traditional/*adverse effects
Middle Aged
Time Factors

Figure

• 

  Fig. 1 Bone marrow biopsy shows mild hypocellular marrow with 40% cellularity (A) (H&E stain, ×100) and erythroid hyperplasia (B) (H&E stain, ×400).

Reference

1. Ernst E. Toxic heavy metals and undeclared drugs in Asian herbal medicines. Trends Pharmacol Sci. 2002. 23:136–139.

2. Ernst E, Thompson Coon J. Heavy metals in traditional Chinese medicines: a systematic review. Clin Pharmacol Ther. 2001. 70:497–504.

3. Hall AH. Chronic arsenic poisoning. Toxicol Lett. 2002. 128:69–72.

4. Gochfeld M. Brooks S, Gochfeld M, Herzstein J, editors. Chemical agents. Environmental medicine. 1995. St. Louis: Mosby;592–614.

5. Tay CH, Seah CS. Arsenic poisoning from anti-asthmatic herbal preparations. Med J Aust. 1975. 2:424–428.

6. Wong ST, Chan HL, Teo SK. The spectrum of cutaneous and internal malignancies in chronic arsenic toxicity. Singapore Med J. 1998. 39:171–173.

7. Cuncha J, Pereira L, Pun MI, Lopes V, Vong SK. Arsenic and acute lethal intoxication. Hong Kong Pharm J. 1998. 7:50–53.

8. Bates MN, Smith AH, Hopenhayn-Rich C. Arsenic ingestion and internal cancers: a review. Am J Epidemiol. 1992. 135:462–476.

9. Chiou HY, Hsueh YM, Liaw KF, Horng SF, Chiang MH, Pu YS, Lin JS, Huang CH, Chen CJ. Incidence of internal cancers and ingested inorganic arsenic: a seven-year follow-up study in Taiwan. Cancer Res. 1995. 55:1296–1300.

10. Johnson LR, Farmer JG. Use of human metabolic studies and urinary arsenic speciation in assessing arsenic exposure. Bull Environ Contam Toxicol. 1991. 46:53–61.

11. Valbonesi M, Bruni R. Clinical application of therapeutic erythrocytapheresis. Transfus Sci. 2000. 22:183–194.

12. Whang DH, Kim SH, Song JH, Kim DW. Therapeutic RBC exchange in a patient with severe Plasmodium falciparum infection. Korean J Blood Transfusion. 1997. 8:147–151.