Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 11) Table 101- 5 Drugs that Carry Risk of Clinical Hemolysis in Persons with G6PD Deficiency Definite Risk Possible Risk Doubtful Risk Antimalarials Primaquine Chloroq uine Quinine Dapsone/chlorp roguanil Sulphonamides/s ulphones Sulphametoxaz ole Sulfasala zine Sulfisoxaz ole Others Sulfadim idine Sulfadiazi ne Dapsone Antibacterial/anti biotics Cotrimoxazole Ciproflo xacin Chloramp henicol Nalidixic acid Norfloxa cin p- Aminosalicylic acid Nitrofurantoin Niridazole Antipyretic/analg esics Acetanilide Acetylsa licylic acid high dose (>3 g/d) Acetylsali cylic acid <3 g/d Phenazopyridin e (Pyridium) Acetamino phen Phenacetin Other Naphthalene Vitamin K analogues Doxorubic in Methylene blue Ascorbic acid >1 g Probeneci d Rasburic ase Table 101- 6 Diseases/Clinical Situations with Predominantly Intravascular Hemolysis Onset/ Main Approp riate Comme Time Course Mechanism Diagnostic Procedure nts Mismatche d blood transfusion Abrupt Nearly always ABO incompatibility Repeat cross match Paroxysmal nocturnal hemoglobinuria (PNH) Chronic with acute exacerbations Comple ment (C)- mediated destruction of CD59(– ) red cells Flow cytometry to d isplay a CD59(– ) red cell population Exacerba tions due to C activation through any pathway Paroxysmal cold hemoglobinuria (PCH) Acute Immune lysis of normal red cells Test for Donath- Landsteiner antibody Often triggered by viral infection Septicemia Very acute Exotoxi ns produced by Blood cultures Other organisms may Clostridium perfringens be responsible Microangio pathic Acute or chronic Red cell fragmentation Red cell morphology on blood smear Different causes ranging from endothelial damage to heman gioma to leaky prosthetic heart valve March hemoglobinuria Abrupt Mechan ical destruction Targete d history taking Favism Acute Destruc tion of older fraction of G6PD- deficient red G6PD assay Triggere d by ingestion of large dish of fava beans; but t rigger can be cells infection or drug instead . Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 11) Table 101- 5 Drugs that Carry Risk of Clinical Hemolysis in. Chronic with acute exacerbations Comple ment (C)- mediated destruction of CD59(– ) red cells Flow cytometry to d isplay a CD59(– ) red cell population Exacerba tions due to C activation. hemoglobinuria (PCH) Acute Immune lysis of normal red cells Test for Donath- Landsteiner antibody Often triggered by viral infection Septicemia Very acute Exotoxi ns produced by Blood cultures