[Phenacetin-induced hemolytic anemia misdiagnosed as unstable hemoglobinopathy]

A 30-year-old woman was admitted in August 1984 with anemia. She had an initial hemolytic attack in 1977. Unstable hemoglobinopathy was suspected. Despite splenectomy in 1979, hemolytic attacks continued. On admission, she was anemic and cyanotic. Hb heat denaturation test was positive. However, the first structure of amino acid of hemoglobin was normal. A large amount of white powder was found in her belongings, and was later identified as phenacetin. N-acetyl-P-aminophenol, a metabolite of phenacetin was demonstrated in her urine. Hemolytic attacks disappeared completely after she stopped taking phenacetin.