Methyldopa, intravascular haemolysis and renal disease. A case report

A 74-year-old man, who was receiving methyldopa to control systemic hypertension, presented to hospital in biventricular cardiac failure. He was found to be severely anaemic and jaundiced as a result of acute intravascular haemolysis with prominent haemoglobinuria. The cardiac failure and anaemia were initially refractory to fluid restriction and diuretics, but responded to red cell transfusion. Renal failure supervened, probably on the basis of hypoperfusion as a consequence of diuresis and hypotension. The patient died suddenly, possibly from myocardial infarction. Acute intravascular destruction of red cells in association with methyldopa appears not to have been previously reported.