Streptomycin-induced hemolytic anemia.

Abstract

Introduction Two major mechanisms are generally implicated in drug-induced hemolytic anemia. (1) A genetically determined deficiency of erythrocyte glucose-6-phosphate dehydrogenase renders the red cell susceptible to the hemolytic action of certain ordinarily harmless drugs. This was first described in primaquine-induced anemia 1 and subsequently in anemia due to numerous other drugs. 2 (2) A drug-erythrocyte complex stimulates the production of antibodies which are capable of destroying the patient's erythrocytes in the presence of the drug. Stibophen (Fuadin) 3 was the first drug reported to cause hemolysis by this haptenlike action. Other drugs similarly implicated include quindine, 4 methylethylhydantoin ( Mesantoin), 5 phenacetin, 6 and aminosalicylic acid. 6 Other agents such as sodium taurocholate and saponin can cause hemolysis 7 apparently by a direct lytic action on the erythrocytes; this direct mechanism, however, is rarely of clinical significance. The following is the first reported case of streptomycin-induced hemolytic anemia, the mechanism of