Abstract
Isoniazid induced sideroblastic anemia is a rare event. We report case of a 45 year old Caucasian women with development of severe anaemia 4 month after introduction of Isoniazid as part of Tuberculosis treatment. While haemoglobin fell to 47 g/L and erythrocyte count to 1.5 G/L, reticulocytes were very low (reticulocyte production index of 0.48), but bone marrow aspirate showed an accelerated erythropoiesis with ringsideroblasts. Anaemia rapidly resolved after cessation of Isoniazid. We postulate an Isoniazid induced inhibition of the δ-Amino-levulinat-synthase resulting in marked depletion of heam synthesis.
Highlights
While haemoglobin fell to 47 g/L and erythroly cyte count to 1.5 G/L, reticulocytes were very n low, but bone marrow aspirate showed an accelerated o erythropoiesis with ringsideroblasts
We postulate an Isoniazid induced inhibition s of the δ-Amino-levulinat-synthase resulting in u marked depletion of heam synthesis. rcial Case Report e A 45-year old Caucasian women was diagm nosed with tuberculous spondylitis and paraspinal abscess
Two major forms of anemia are decribed as side effect of treatment with Isoniazid
Summary
The patient did not come to the visits until April 12. At that time the patient complaint about shortness of breath. Correspondence: Rein Jan Piso, Department of Medicine, Kantonsspital, 4600 Olten, Switzerland. Kantonsspital, Olten, Switzerland 2Department of Medicine, Haematology, Kantonsspital, Olten, Switzerland was not changed. Two packs of red blood cells where transfused the day after. Haemoglobin level had risen only to 51 gram/L. Bone marrow aspiration and biopsy was per-. Formed on April 20 (under Isoniazid-treat- This work is licensed under a Creative Commons ment). Isoniazid was substituted by moxi- Attribution 3.0 License (by-nc 3.0)
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