ACUTE HEMOLYTIC ANEMIA FROM THE SULFONAMIDES

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Abstract
The acute hemolytic anemia of sulf-anilamide and sulfapyridine therapy was studied in 4 cases, 2 of them fatal. Erythrocytes which survived hemolysis, the serum (which contained the products of hemolysis), and the urine were examined by the objective photoelectric spectrophotometer. The red cells that survived hcmolysis were essentially normal, containing little met-Hb or sulf-Hb. The serum 12-48 hrs. after onset of hemolysis contained 0.4-1.7 gs. per 100 cc. of 3 blood pigments, Hb, met-Hb and Fairley''s new pigment, methemalbumin. This pigment was then prepared according to Fairley''s technic of incubating human plasma with Hb and a method for its measurement given. No evidence was found for its involvement in the hemolytic process; it was not excreted in the urine. The relation of met-Hb and hemolysis to oxidation products of the sulfonamides was discussed. Approximate calculation was made of the amts. of Hb liberated in these explosive hemoglobinemias. Comparison with the small amts. left in the circulation after 12-48 hrs., and the still smaller amts. (4% or less) excreted by the kidneys, showed that the body had means of removing rapidly 500-700 gs. of Hb from the plasma without the aid of renal excretion. Shock was a prominent symptom, most marked in the fatal cases. The hemolyzed cells in the fatal cases represented about 30% of the total blood vol. This much reduction in the blood vol. following the demonstrated rapid removal of the products of hemolysis from the circulation might be a factor in the explanation of hemolytic shock.