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Double Bite Cells in Oxidative Hemolytic Anemia.

Jacob R Anderson1,2, Marie A Hollenhorst2,3

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American Journal of Hematology
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This summary is machine-generated.

Double bite cells on blood smears indicate oxidant hemolysis from recreational alkyl nitrite use. This diagnosis was confirmed in a patient with normal glucose-6-phosphate dehydrogenase (G6PD) levels.

Keywords:
anemiashemoglobinhemolytic anemiaoxidationred blood cell morphology

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Area of Science:

  • Hematology
  • Toxicology

Background:

  • Oxidant hemolysis is a serious condition that can result from exposure to certain substances.
  • Recreational alkyl nitrite use is known to cause various health issues, including hemolysis.

Observation:

  • A patient presented with findings suggestive of hemolysis.
  • Peripheral blood smear examination revealed the presence of characteristic 'bite cells'.

Findings:

  • The presence of bite cells strongly suggested oxidant hemolysis.
  • The patient's hemolysis was directly linked to recreational alkyl nitrite use.
  • Crucially, the patient had normal glucose-6-phosphate dehydrogenase (G6PD) levels, ruling out a common genetic predisposition.

Implications:

  • This case highlights the diagnostic utility of peripheral blood smear findings in alkyl nitrite-induced oxidant hemolysis.
  • It underscores that G6PD deficiency is not a prerequisite for this type of hemolysis.
  • Clinicians should consider alkyl nitrite exposure in patients presenting with unexplained hemolysis, even with normal G6PD status.