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Drug-associated "bite cell" hemolytic anemia

D Yoo1, L S Lessin

  • 1Department of Medicine, Providence Hospital, Washington, D.C.

The American Journal of Medicine
|March 1, 1992
PubMed
Abstract

Insights

Peripheral smear examination is crucial for diagnosing drug-induced hemolytic anemia. Identifying bite cells and removing the offending drug leads to recovery.

Area of Science:

  • Hematology
  • Pathology
  • Toxicology

Background:

  • Drug-induced hemolytic anemia is often linked to methemoglobinemia and Heinz bodies.
  • Bite cells, a type of poikilocyte, are characterized by semicircular cell margin defects.
  • Oxidant drug injury can cause these morphological changes in red blood cells.

Purpose of the Study:

  • To highlight the diagnostic significance of peripheral smear examination in drug-associated hemolytic anemia.
  • To detail the morphological characteristics of bite cells using light and scanning electron microscopy.
  • To discuss the pathophysiological mechanisms underlying bite cell formation.

Main Methods:

  • Retrospective analysis of clinical and laboratory data from eight patients with bite cell hemolytic anemia.
  • Standard hematologic evaluations for hemolytic anemia were performed.
  • Bite cell percentage was calculated by examining 500 red blood cells per smear.

Main Results:

  • Peripheral smears revealed bite cells (5.5%–13.6%) and occasional blister cells.
  • Hematocrit reduction (3.0%–13.2%) and reticulocytosis (2.3%–15.4%) were observed.
  • Drug withdrawal and treatment led to improvement and disappearance of bite cells, with a correlation between bite cell percentage and hemolysis markers.

Conclusions:

  • Peripheral smear examination is vital for early diagnosis and management of bite cell hemolytic anemia.
  • Discontinuing the causative drug and treating underlying conditions improves this hemolytic anemia.
  • Morphological identification of bite cells aids in managing drug-induced red blood cell injury.

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