Arsine toxicity treated with red blood cell and plasma exchanges

Area of Science:

• Toxicology
• Hematology
• Nephrology

Background:

• Arsine gas (AsH(3)) inhalation causes acute toxicity with no known antidote.
• Arsine toxicity can lead to intravascular hemolysis and acute renal failure, often requiring dialysis.
• Red blood cell exchange (RBC-E) and plasma exchange (PE) are potential therapeutic interventions.

Observation:

• A 46-year-old man experienced symptoms of arsine toxicity, including nausea, vomiting, and dark urine, within 6 hours of exposure.
• The patient developed acute renal failure with significantly elevated arsenic levels (1250 microg/L).
• Laboratory findings revealed severe hemolysis, indicated by low hematocrit, elevated bilirubin and LDH, and undetectable haptoglobin.

Findings:

• Emergent red blood cell exchange (RBC-E) revealed grossly hemolyzed plasma.
• Following two RBC-E procedures, two plasma exchange (PE) sessions, and daily hemodialysis, the patient achieved complete recovery over one month.
• This case highlights the severe hemolytic and nephrotoxic effects of arsine gas exposure.

Implications:

• Early administration of red blood cell exchange (RBC-E) is crucial for patients with arsine toxicity-induced intravascular hemolysis.
• Plasma exchange (PE) may further aid in removing hemolysis byproducts and reducing arsenic levels.
• Combined therapeutic strategies including RBC-E, PE, and hemodialysis can be effective in managing severe arsine gas poisoning.