DOCSLIB.ORG

Perinatal/Neonatal Case Presentation Perinatal Toxicity of Domestic Naphthalene Exposure

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Perinatal/Neonatal Case Presentation Perinatal Toxicity of Domestic Naphthalene Exposure Perinatal/Neonatal Case Presentation Perinatal Toxicity of Domestic Naphthalene Exposure Eleanor J. Molloy, MB, PhD together with cyanosis, prompted transfer of the infant to the Benedict A. Doctor, MD intensive care nursery. Michael D. Reed, PharmD He was symmetrical for gestational age with normal vital signs. Michele C. Walsh, MD The infant was alert with no respiratory distress, a normal chest X- ray and arterial blood gas. However, his appearance was pale and cyanotic with a pulse-oximetry reading of 84% saturation, despite supplemental blow-by 100% oxygen. His hematocrit was 30% and Naphthalene-containing mothballs can cause methemoglobinemia on reticulocyte count 7.9%. There were 136 nucleated red blood cells inhalation. We describe a mother with hemolytic anemia and (RBCs) per 100 white blood cells and the blood smear showed methemoglobinemia associated with elevated levels of naphthalene evidence of acute hemolysis but no Heinz bodies. The baby’s blood following exposure to mothballs. Her newborn infant had identical type was group O, Rh-positive with negative antibody screen and a symptoms requiring mechanical ventilation and an exchange transfusion total bilirubin of 6 mg/dl (102 mmol/l) at birth. Urinalysis revealed for resolution. moderate blood/hemoglobin, proteinuria, with rare RBCs, and no Journal of Perinatology (2004) 24, 792–793. doi:10.1038/sj.jp.7211195 myoglobin. Methemoglobin levels were 11.3 (normal <1%) and 1.3% in the neonatal and maternal samples, respectively. At 7 hours of age, increasing tachypnea and oxygen requirement necessitated intubation and mechanical ventilation with 100% oxygen. He was extubated to room air at 40 hours of age INTRODUCTION by which time his methemoglobin level had decreased to 4.8%. Most neonates admitted to the intensive care unit with cyanosis However, his total bilirubin continued to rise, despite the initiation unresponsive to supplemental oxygen have either cardiovascular or of double phototherapy with super-blue light bulbs (General parenchymal lung disease. A minority will have Electric; F20 T12/BB) at birth. It reached 20 mg/dl (342 mmol/l) methemoglobinemia, readily detectable by the persistent chocolate- with an end-tidal carbon monoxide (ETCOc, Natus Inc.; 9,10) brown appearance of the blood when exposed to air. We present an measured 8.8 ppm (normal <2 ppm) at 50 hours of age, infant born with methemoglobinemia due to antepartum maternal indicating brisk hemolysis. A double-volume exchange transfusion naphthalene inhalation from mothballs. was performed, which lowered his bilirubin to 10 mg/dl (171 mmol/l) although there was a subsequent rebound after exchange to a maximum level of 14 mg/dl (239 mmol/l). He was discharged home in healthy condition at 16 days of age. CASE REPORT We suspected a transplacentally acquired toxin because both the A 15-year-old primigravid African-American woman, blood group mother and the infant had a new onset hemolytic anemia. O, Rh-positive with negative antibody screen, presented with Following persistent questioning of the family, it transpired that an preterm labor at 36 weeks gestation. On admission, she was entire box of moth flakes (100% refined naphthalene) had spilt diagnosed with a hemolytic anemia of unknown etiology and had into a heating vent approximately 1 week prior to delivery. The an unremarkable past medical history. Following oxytocin resultant fumes had necessitated the windows remaining open augmentation for fetal distress she vaginally delivered a hypotonic, despite subzero external environmental temperatures. Naphthalene cyanotic and apneic male infant. He received bag-mask ventilation was not detected in the infant’s blood after exchange transfusion, with spontaneous breathing but persistent cyanosis giving Apgars of and no urine samples were available prior to this procedure. 2 at 1 minute and 6 at 5 minutes. The passage of dark urine, However, a urinary metabolite of naphthalene was found to be present in the mother’s urine sample from admission. Both mother and infant were well 1 year later. Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. DISCUSSION Address correspondence and reprint requests to Eleanor Molloy, MB, PhD, Division of Neonatology, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave., Cleveland, OH 44106, Methemoglobinemia (methemoglobin concentration >1%) is an 1 USA. important differential diagnosis in all cyanotic patients. (Table 1) Journal of Perinatology 2004; 24:792–793 r 2004 Nature Publishing Group All rights reserved. 0743-8346/04 $30 792 www.nature.com/jp Perinatal Toxicity of Domestic Naphthalene Exposure Molloy et al. temporal linkage and not proven by assay. Although the parent Table 1 Causes of Methemoglobinemia compound is devoid of hemolytic properties, its oxidative Congenital metabolite, alpha-naphthol, possesses potent hemolytic activity Homozygous deficiency of cytochrome b5 reductase resulting in hemoglobinuria and methemoglobinemia. A single Hemoglobin M previous report of suspected transplacental naphthalene poisoning Acquired exists in the literature5 and a case series of 21 newborns was also Drug exposures described who developed severe hemolysis after inhalation exposure Oral or intravenous nitroglycerin to naphthalene-containing mothballs.6 Naphthalene levels were Topical benzocaine (teething gel, topical ointments, hemorrhoidal cream) Topical or injected local anesthetics not available in this era. Following these reports, most Overdose of phenazopyridine manufacturers have substituted the chemical, Overdose of dapsone paradichlorobenzene, which is less toxic, for naphthalene as the Naphthalene inhalation active compound in most mothball and diaper pail deodorizer Toxic exposures products. Nitrates in well water The treatment of methemoglobin due to a toxic exposure is Recreational inhalation of nitrites (amylnitrite) generally supportive by correcting anemia, exchange transfusion in Aniline dyes (print marks on diapers, leather dyes in new shoes) cases of severe poisoning and removal of the toxin.1 The use of Adapted from: Curry SC, Carlton MW. Hematologic consequences of poisoning. methylene blue, a soluble guanylate cyclase inhibitor, should be In: LM Haddad, MW Shannon, JF Winchester, editors. ‘‘Clinical Management of avoided in infants, as it can cause methemoglobinemia and Poisoning and Drug Overdose’’. 3rd Ed, Philadelphia, PA: WB Saunders; 1998. hemolytic anemia.1 This case is the first documenting exposure by drug assay rather Methemoglobin is formed by the oxidation of ferrous (Fe2 þ ) than history alone. We speculate that the enormous surface area of hemoglobin to ferric (Fe3 þ ) hemoglobin and cannot bind oxygen. the moth flakes combined with heat, led to a massive inhalation It produces marked cyanosis even at concentrations that are not exposure of naphthalene, as evident by ongoing hemolysis and life threatening. Additionally, due to the spectrophotometric presence of the metabolite in the infant’s mother 1 week after the absorbance properties of methemoglobin, readings on pulse- initial exposure. Methemoglobinemia causing cyanosis and 2 oximetry trend toward 85%. However, measurement of PO2 is not respiratory failure is unusual in the perinatal period and maternal affected by the presence of methemoglobin. Therefore, a pulse- poisoning should be considered. oximeter reading that is inconsistent with oxygen saturation calculated using the PO2 measurement is suggestive of methemoglobinemia. This infant’s ventilation was managed using References trends in both PO2 and pulse oximetry while recognizing the 1. Curry S. Methemoglobinemia. Ann Emerg Med 1982;11:214–21. disparity between them. A major potential cause of 2. Delwood L, O’Flaherty D, Pregean EJ, Giesecke AH. Methemoglobinemia and methemoglobinemia among neonates is nitric oxide its effect on pulse oximetry. Crit Care Med 1991;19:988. administration for treatment of hypoxic respiratory failure.3 Infants 3. The Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full- are more sensitive than adults to methemoglobin-producing agents term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med 1997;336:597–604. due to lower levels of NADH-dependent methemoglobin reductase 4 4. Kravitz W, Elegant LD, Kaiser E, Kagan BM. Methemoglobin values in activity, which may be more pronounced in preterm infants. premature and mature infants and children. Am J Dis Child 1956;91:1. Naphthalene is absorbed following oral, dermal, and inhalation 5. Anziulewicz JA, Dick HJ, Chiarulli EE. Transplacental naphthalene poisoning. exposure and its association with hemolytic anemia is well Am J Obstet Gynecol 1959;78:519–21. described in most textbooks. However, the association of 6. Valaes T, Psyros AD, Phaedron F. Acute hemolysis due to naphthalene methemoglobinemia with naphthalene exposure is based on inhalation. J Pediatr 1963;63:904–15. Journal of Perinatology 2004; 24:792–793 793.
Load more

Recommended publications
  • 18,8 Quaternary Structure of Proteins
    570 CHAPTERt8 Amino Acids,Peptides, and Proteins 18,8Quaternary structure of proteins AIMS: Todefine the termssubunit dnd quaternarystructure. Io describethe quoternorystructure of hemoglobin.To distinguishomong oxyhemoglobin,deoxyhemoglobin, ond methemoglobin. Someproteins consist of more than one pollpeptide chain. Theseindiuid- ual chains are calledsubunits of the protein. Proteins composedof subunits In some proteins, polypeptide are said to haue quaternary structure. Many proteins have structures that chains aggregateto form contain subunits. Proteins consistingof dimers (two subunits), tetramers quaternary structures. (four subunits), and hexamers (six subunits) are fairly common. The pro- teins that comprise the individual subunits may be identical, or they may be different. Like the secondary and tertiary structures, the quaternary structure of a protein is determined by its primary structure. The pollpep- tide chains of subunits are held in place by the same forces that determine tertiary structure-hydrogen bonds, salt bridges, and sometimes disulfide bridges-except the forces are betweenthe polypeptide chains of the sub- units instead of within them. Hydrophobic aliphatic and aromatic side chains of subunits can aggregateto exclude water. Hemoglobin-the globular oxygen-transport protein of blood-is an example of a protein that has a quaternary structure. Max Perutz, also of the Medical ResearchCouncil laboratories,determined the structure of horse blood hemoglobin in 1959.Hemoglobin is a larger molecule than myoglo- bin. The hemoglobin molecule has a molar mass of 64,500.It contains about 5000 individual atoms, excluding hydrogens, in 574 amino acid residues. The quaternary structure of hemoglobin consistsof four peptide sub- units. TWo of the subunits are identical and are called the alpha subunits.
    [Show full text]
  • Predictors of Autoimmune Hemolytic Anemia in Beta-Thalassemia
    Blood Cells, Molecules and Diseases 79 (2019) 102342 Contents lists available at ScienceDirect Blood Cells, Molecules and Diseases journal homepage: www.elsevier.com/locate/bcmd Predictors of autoimmune hemolytic anemia in beta-thalassemia patients with underlying red blood cells autoantibodies T ⁎ Monia Ben Khaleda,b, , Monia Ouedernia,b, Nessrine Sahlia,b, Nawel Dhouibb, Ahmed Ben Abdelazizc, Samia Rekayaa,b, Ridha Koukia,b, Houda Kaabid, Hmida Slamad, Fethi Melloulia,b, Mohamed Bejaouia,b a Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia b Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia c Information System Directions, Sahloul University Hospital, Sousse, Tunisia d National Center of Blood Transfusion, Tunis, Tunisia ARTICLE INFO ABSTRACT Editor: Mohandas Narla In beta-thalassemia patients, erythrocyte autoantibodies can remain silent or lead to Autoimmune Hemolytic Keywords: Anemia (AIHA).The aim of this study was to identify predictors of AIHA in beta-thalassemia patients with Autoimmune hemolytic anemia positive Direct Antiglobulin Test (DAT), in Tunisia. Thalassemia This longitudinal prognosis study was carried out on beta-thalassemia patients with a positive confirmed Transfusion DAT. Predictors of AIHA were identified the Kaplan-Meier method. A Cox model analysis was used to identify Autoantibodies independent predictors. Red blood cells Among 385 beta thalassemia patients, 87 developed positive DAT (22.6%). Autoimmune hemolytic anemia Direct antiglobulin test was occurred in 25 patients. Multivariate analysis showed that AIHA was independently associated with beta- thalassemia intermedia and similar family history of AIHA. Splenectomy in patients with positive DAT was independently associated with an increased risk of AIHA (HR = 6.175, CI: 2.049–18.612, p < 0.001).
    [Show full text]
  • The Role of Methemoglobin and Carboxyhemoglobin in COVID-19: a Review
    Journal of Clinical Medicine Review The Role of Methemoglobin and Carboxyhemoglobin in COVID-19: A Review Felix Scholkmann 1,2,*, Tanja Restin 2, Marco Ferrari 3 and Valentina Quaresima 3 1 Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland 2 Newborn Research Zurich, Department of Neonatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; [email protected] 3 Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; [email protected] (M.F.); [email protected] (V.Q.) * Correspondence: [email protected]; Tel.: +41-4-4255-9326 Abstract: Following the outbreak of a novel coronavirus (SARS-CoV-2) associated with pneumonia in China (Corona Virus Disease 2019, COVID-19) at the end of 2019, the world is currently facing a global pandemic of infections with SARS-CoV-2 and cases of COVID-19. Since severely ill patients often show elevated methemoglobin (MetHb) and carboxyhemoglobin (COHb) concentrations in their blood as a marker of disease severity, we aimed to summarize the currently available published study results (case reports and cross-sectional studies) on MetHb and COHb concentrations in the blood of COVID-19 patients. To this end, a systematic literature research was performed. For the case of MetHb, seven publications were identified (five case reports and two cross-sectional studies), and for the case of COHb, three studies were found (two cross-sectional studies and one case report). The findings reported in the publications show that an increase in MetHb and COHb can happen in COVID-19 patients, especially in critically ill ones, and that MetHb and COHb can increase to dangerously high levels during the course of the disease in some patients.
    [Show full text]
  • The Hematological Complications of Alcoholism
    The Hematological Complications of Alcoholism HAROLD S. BALLARD, M.D. Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia. Alcohol also interferes with the production and function of white blood cells, especially those that defend the body against invading bacteria. Consequently, alcoholics frequently suffer from bacterial infections. Finally, alcohol adversely affects the platelets and other components of the blood-clotting system. Heavy alcohol consumption thus may increase the drinker’s risk of suffering a stroke. KEY WORDS: adverse drug effect; AODE (alcohol and other drug effects); blood function; cell growth and differentiation; erythrocytes; leukocytes; platelets; plasma proteins; bone marrow; anemia; blood coagulation; thrombocytopenia; fibrinolysis; macrophage; monocyte; stroke; bacterial disease; literature review eople who abuse alcohol1 are at both direct and indirect. The direct in the number and function of WBC’s risk for numerous alcohol-related consequences of excessive alcohol increases the drinker’s risk of serious Pmedical complications, includ- consumption include toxic effects on infection, and impaired platelet produc- ing those affecting the blood (i.e., the the bone marrow; the blood cell pre- tion and function interfere with blood cursors; and the mature red blood blood cells as well as proteins present clotting, leading to symptoms ranging in the blood plasma) and the bone cells (RBC’s), white blood cells from a simple nosebleed to bleeding in marrow, where the blood cells are (WBC’s), and platelets.
    [Show full text]
  • Concurrent Sickle Cell Anemia and Alpha-Thalassemia. Effect on Pathological Properties of Sickle Erythrocytes
    Concurrent sickle cell anemia and alpha-thalassemia. Effect on pathological properties of sickle erythrocytes. S H Embury, … , G Monroy, N Mohandas J Clin Invest. 1984;73(1):116-123. https://doi.org/10.1172/JCI111181. Research Article The concurrence of sickle cell anemia and alpha-thalassemia results in less severe hemolytic anemia apparently as a result of reduced intraerythrocytic concentration of hemoglobin S and its retarded polymerization. We have evaluated the effect of alpha-globin gene number on several interrelated properties of sickle erythrocytes (RBC) that are expected to correlate with the hemolytic and rheologic consequences of sickle cell disease. The irreversibly sickled cell number, proportion of very dense sickle RBC, and diminished deformability of sickle RBC each varied directly with alpha-globin gene number. Sickle RBC density was a direct function of the mean corpuscular hemoglobin concentration (MCHC). Even in nonsickle RBC, alpha-globin gene number varied directly with RBC density. Despite differences in alpha-globin gene number, sickle RBC of the same density had the same degree of deformability and dehydration. These data indicate that the fundamental effect of alpha-thalassemia is to inhibit the generation of sickle RBC having high density and MCHC, and that the other beneficial effects of sickle RBC are secondary to this process. The less consistent effect on overall clinical severity reported for subjects with this concurrence may reflect an undefined detrimental effect of alpha-thalassemia, possibly on the whole blood viscosity or on sickle RBC membrane-mediated adherence phenomena. Find the latest version: https://jci.me/111181/pdf Concurrent Sickle Cell Anemia and a-Thalassemia Effect on Pathological Properties of Sickle Erythrocytes Stephen H.
    [Show full text]
  • Concentration of NADH-Cytochrome B5 Reductase in Erythrocytes of Normal and Methemoglobinemic Individuals Measured with a Quantitative Radioimmunoblotting Assay
    Concentration of NADH-cytochrome b5 reductase in erythrocytes of normal and methemoglobinemic individuals measured with a quantitative radioimmunoblotting assay. N Borgese, … , G Pietrini, S Gaetani J Clin Invest. 1987;80(5):1296-1302. https://doi.org/10.1172/JCI113205. Research Article The activity of NADH-cytochrome b5 reductase (NADH-methemoglobin reductase) is generally reduced in red cells of patients with recessive hereditary methemoglobinemia. To determine whether this lower activity is due to reduced concentration of an enzyme with normal catalytic properties or to reduced activity of an enzyme present at normal concentration, we measured erythrocyte reductase concentrations with a quantitative radioimmunoblotting method, using affinity-purified polyclonal antibodies against rat liver microsomal reductase as probe. In five patients with the "mild" form of recessive hereditary methemoglobinemia, in which the activity of erythrocyte reductase was 4-13% of controls, concentrations of the enzyme, measured as antigen, were also reduced to 7-20% of the control values. The concentration of membrane-bound reductase antigen, measured in the ghost fraction, was similarly reduced. Thus, in these patients, the reductase deficit is caused mainly by a reduction in NADH-cytochrome b5 reductase concentration, although altered catalytic properties of the enzyme may also contribute to the reduced enzyme activity. Find the latest version: https://jci.me/113205/pdf Concentration of NADH-Cytochrome b5 Reductase in Erythrocytes of Normal and Methemoglobinemic
    [Show full text]
  • The First Korean Family with Hemoglobin-M Milwaukee-2 Leading to Hereditary Methemoglobinemia
    Case Report Yonsei Med J 2020 Dec;61(12):1064-1067 https://doi.org/10.3349/ymj.2020.61.12.1064 pISSN: 0513-5796 · eISSN: 1976-2437 The First Korean Family with Hemoglobin-M Milwaukee-2 Leading to Hereditary Methemoglobinemia Dae Sung Kim1, Hee Jo Baek1,2, Bo Ram Kim1, Bo Ae Yoon1,2, Jun Hyung Lee3, and Hoon Kook1,2 1Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun; 2Department of Pediatrics, Chonnam National University Medical School, Gwangju; 3Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea. Hemoglobin M (HbM) is a group of abnormal hemoglobin variants that form methemoglobin, which leads to cyanosis and he- molytic anemia. HbM-Milwaukee-2 is a rare variant caused by the point mutation CAC>TAC on codon 93 of the hemoglobin sub- unit beta (HBB) gene, resulting in the replacement of histidine by tyrosine. We here report the first Korean family with HbM-Mil- waukee-2, whose diagnosis was confirmed by gene sequencing. A high index of suspicion for this rare Hb variant is necessary in a patient presenting with cyanosis since childhood, along with methemoglobinemia and a family history of cyanosis. Key Words: ‌Hemoglobin M-Milwaukee-2, methemoglobinemia, cyanosis, congenital hemolytic anemia INTRODUCTION tion pathway.6 Methemoglobinemia occurs when metHb lev- els exceed 1.5% in blood.7 Hereditary methemoglobinemia is Hemoglobinopathy refers to abnormalities in hemoglobin often caused by methemoglobin reductase enzyme deficiency,
    [Show full text]
  • Evidence of the Existence of a High Spin Low Spin Equilibrium in Liver Microsomal Cytochrome P450, and Its Role in the Enzymatic Mechanism* H
    CROATICA CHEMICA ACTA CCACAA 49 (2) 251-261 (1977) YU ISSN 0011-1643 CCA-996 577.15.087.8 :541.651 Conference Paper Evidence of the Existence of a High Spin Low Spin Equilibrium in Liver Microsomal Cytochrome P450, and its Role in the Enzymatic Mechanism* H. Rei:n, 0. Ristau, J. Friedrich, G.-R. Jiinig, and K. RuckpauL Department of Biocatalysis, C'entral Institute of Molecular Biology, Academy of Sciences of the GDR 1115 Berlin, GDR Received November 8, 1976 In rabbit liver microsomal cytochrome P450 a high spin (S = = 5/2) low spin (S = 1/2) equilibrium has been proved to exist by recording temperature difference spectra in the Soret and in the visible region of the absorption spectrum of solubilized cytochrome P450. In the presence of type II substrates the predominantly low spin state of cytochrome P450 is maintained, only a very small shift to lower spin is observed. Ligands of the heme iron, such as cyanide and imidazole, pr9duce a pure low spin state and therefore in the presence of these ligands no temperature difference spectra can be obtained. In the presence of type I substrate, however, the spin equilibrium is shifted to the high spin state. The extent of this shift (1) depends on specific properties of the substrate and (2) it is generally relatively small, up to about 80/o in the case of substrates investigated so far. INTRODUCTION The first step in the reaction cycle of cytochrome P450 is the binding of the substrate to the enzyme. The binding is connected with changes in the absorption spectrum especially in the Soret region from which the binding constant can be evaluated1• Moreover, in the case of the so far best known cytochrome P450 from Pseudomonas putida it has been established that at substrate binding the low spin state of the heme iron is changed into the high spin state2• In the presence of camphor, a specific substrate, bacterial cytochrome P450 exhibits in the EPR spectrum g values of 8, 4, and 1.8, typical of high spin ferric heme iron in a strong distorted rhombic field.
    [Show full text]
  • Case Report on Methylene Blue Induced Hemolytic Anemia
    Available online at www.ijmrhs.com al R edic ese M a of rc l h a & n r H u e o a J l l t h International Journal of Medical Research & a n S ISSN No: 2319-5886 o c i t i Health Sciences, 2019, 8(5): 83-85 e a n n c r e e t s n I • • I J M R H S Case Report on Methylene Blue Induced Hemolytic Anemia Sulfath T.S1, Bhanu Kumar M2, Koneru Vasavi1, Aparna R Menon1 and Ann V Kuruvilla1* 1 Department of Pharmacy Practice, JSS College of Pharmacy, Mysuru Jagadguru Shri Shivarathreeshwara Academy of Higher Education and Research, Karnataka, India 2 Department of General Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Karnataka, India *Corresponding e-mail: [email protected] ABSTRACT A 22-years old male patient was admitted to a tertiary care hospital with complaints of an alleged history of intentional poisoning (organophosphorus compound and nitrofurantoin) and developed hemolytic anemia after receiving methylene blue for 8 days. The patient presented with hematuria and hemoglobin level 3.1 which confirmed hemolytic anemia G6PD level was normal. Methylene blue was discontinued and PRBC transfusion (3 pints) was given. After 4 days of blood transfusion, the patient’s Hb level became 9.4 g/dl. Causality assessment was suggestive of a probable relationship between the drug and reaction. Keywords: Hemolytic anemia, Methylene blue, G6PD Abbreviations: G6PD: Glucose-6-phosphate Dehydrogenase; PRBC: Packed Red Blood Cells; LMB: Leucomethylene Blue; NADPH: Nicotinamide Adenine Dinucleotide Phosphate; OP: Organophosphorus; SPO2: Saturation of peripheral oxygen; CBC: Complete Blood Count INTRODUCTION Methylene blue (tetramethylthionine chloride) is a diagnostic agent in kidney function, anti-infective agent, antidote, antiseptic and nutraceutical.
    [Show full text]
  • Role of Methemoglobin and Carboxyhemoglobin Levels in Predicting COVID-19 Prognosis: an Observational Study
    RESEARCH ARTICLE Role of methemoglobin and carboxyhemoglobin levels in predicting COVID-19 prognosis: an observational study Begüm Öktem1, Fatih Üzer2, *, Fatma Mutlu Kukul Güven1, İdris Kırhan3, Mehmet Topal4 1 Department of Emergency Medicine, Kastamonu State Hospital, Kastamonu Turkey 2 Department of Pulmonology, Kastamonu State Hospital, Kastamonu, Turkey 3 Department of Internal Medicine, Harran University Faculty of Medicine, Şanlıurfa, Turkey 4 Department of Biostatistics, Kastamonu University Faculty of Medicine, Kastamonu, Turkey *Correspondence to: Fatih Üzer, MD, [email protected]. orcid: 0000-0001-9318-0458 (Fatih Üzer) Abstract World Health Organization has declared coronavirus disease-19 (COVID-19) as a pandemic. Although there are studies about this novel virus, our knowledge is still limited. There is limited information about its diagnosis, treatment and prognosis. We aimed to investigate the effect of methemoglobin and carboxyhemoglobin levels on the prognosis of COVID-19. In this observational study, patients who were diagnosed with COVID-19 during March 1–April 31, 2020 in a secondary-level state hospital in Turkey were included in the study. COVID-19 diagnosis was confirmed with reverse transcription polymerase chain reaction method, with nasal, oral or sputum specimens. During the period this study was performed, 3075 patients were tested for COVID-19 and 573 of them were hospitalized. Among the hospitalised patients, 23.2% (133) of them had a positive polymerase chain reaction result for COVID-19. A total of 125 patients, 66 (52.8%) males and 59 (47.2%) females, with an average age of 50.2 ± 19.8 years, were included in the study. The most common findings in chest radiogram were ground-glass areas and consolidations, while one-third of the patients had a normal chest radiogram.
    [Show full text]
  • The Formation of Methemoglobin and Sulfhemoglobin During Sulfanilamide Therapy
    THE FORMATION OF METHEMOGLOBIN AND SULFHEMOGLOBIN DURING SULFANILAMIDE THERAPY J. S. Harris, H. O. Michel J Clin Invest. 1939;18(5):507-519. https://doi.org/10.1172/JCI101064. Research Article Find the latest version: https://jci.me/101064/pdf THE FORMATION OF METHEMOGLOBIN AND SULFHEMOGLOBIN DURING SULFANILAMIDE THERAPY By J. S. HARRIS AND H. 0. MICHEL (From the Departments of Pediatrics and Biochemistry, Duke University School of Medicine, Durham) (Received for publication April 8, 1939) Cyanosis almost invariably follows the admin- during the administration of sulfanilamide. Wen- istration of therapeutic amounts of sulfanilamide del (10) found spectroscopic evidence of met- (1). This cyanosis is associated with and is due hemoglobin in every blood sample containing over to a change in the color of the blood. The dark- 4 mgm. per cent sulfanilamide. Evelyn and Mal- ening of the blood is present only in the red cells loy (11) have found that all patients receiving and therefore must be ascribed to one of two sulfanilamide show methemoglobinemia, although causes, a change in the hemoglobin itself or a the intensity is usually very slight. Finally Hart- staining of the red cells with some product formed mann, Perley, and Barnett (12) found cyanosis during the metabolism of sulfanilamide. It is the associated with methemoglobinemia in almost ev- purpose of this paper to assay quantitatively the ery patient receiving over 0.1 gram sulfanilamide effect of sulfanilamide upon the first of these fac- per kilogram of body weight per day. They be- tors-that is, upon the formation of abnormal lieved that the intensity of the methemoglobinemia heme pigments.
    [Show full text]
  • Danchenko A., Lemiasheuski V. INFLUENCE of EXPOSURE
    most exposed to temperature fluctuations are crops. Among them it is necessary to allocate the objects most susceptible to frost and (separately) drought (extremely high temperatures). In the first category should include winter and perennial crops. They are characterized by winterkill or freezing vegetative organs, leading to disease development or death. In assessing the impact DWE must consider not only temperature, but also the period of exposure and the combination with other factors increasing sensitivity of the object and causing damage. Danchenko A., Lemiasheuski V. International Sakharov Environmental Institute of Belarusian State University, Minsk, Republic of Belarus INFLUENCE OF EXPOSURE HELIUM-NEON LASER AT A FRACTION OF METHEMOGLOBIN AND GLYCATED HEMOGLOBIN Blood is a liquid body tissue, which provides transport of all resources and ex- change products for other cells and tissues of the body. In this regard, human blood parameters are a very important feature of health status that reflects its state at a given time. Since the blood is quite labile tissue, so its reacts to external and inter- nal influences. Hemoglobin fractions are its basis, a helium-neon laser of low- intensity radiation was selected as a tool to influence the blood. Irradiation of heli- um-neon laser allows to achieve photobiological biostimulation effect that occurs at low-intensity radiation (λ = 632.8 nm). This effect occurs not only when irradiated blood but also tissues areas with any inflammatory processes. The laser beam is a means for vasodilation, increasing the number of hemoglobin complexes with NO, increasing the amount of erythrocytes, hemoglobin and leukocytes. Hemoglobin is one of the leading acceptor of radiation energy.
    [Show full text]