Congestive heart failure and respiratory arrest secondary to methyldopa-induced hemolytic anemia

We report a case of methyldopa-induced hemolytic anemia in a 64-year-old woman who presented to the emergency department in congestive heart and respiratory failure. She subsequently suffered a respiratory arrest and required endotracheal intubation and brief CPR. After the initial evaluation revealed anemia and a 3+ positive Coombs' test, a diagnosis of methyldopa-induced hemolytic anemia was entertained. Withdrawal of the drug and supportive therapy resulted in the complete recovery of the patient. Emergency physicians should be aware of this syndrome and be able to diagnose it early in its course, avoiding potential morbidity and mortality. A discussion of the pathophysiology, diagnosis, treatment, and prognosis of the syndrome is given.