Hemolysis from exposure to naphthalene mothballs

Acute intravascular hemolysis and methemoglobinemia following naphthalene ball poisoning

Naphthalene (C10H8) is a natural component of fossil fuels such as petroleum, diesel and coal. The common consumer products made from naphthalene are moth repellents, in the form of mothballs or crystals, and toilet deodorant blocks. Major toxic effects of naphthalene are due to precipitation of acute intravascular hemolysis. Very few cases of naphthalene poisoning and its effects have been reported from India. We report a case of accidental naphthalene poisoning, who presented with intravascular hemolysis and methemoglobinemia.

Oxidant stress and haemolysis of the human erythrocyte

The erythrocyte is a highly specialised cell with a limited metabolic repertoire. As an oxygen shuttle, it must continue to perform this essential task while exposed to a wide range of environments on each vascular circuit, and to a variety of xenobiotics across its lifetime. During this time, it must continuously ward off oxidant stress on the haeme iron, the globin chain and on other essential cellular molecules. Haemolysis, the acceleration of the normal turnover of senescent erythrocytes, follows severe and irreversible oxidant injury. A detailed understanding of the molecular mechanisms underlying oxidant injury and its reversal, and of the clinical and laboratory features of haemolysis is important to the medical toxicologist. This review will also briefly review glucose-6-phosphate deficiency, a common but heterogeneous range of enzyme-deficient states, which impairs the ability of the erythrocyte to respond to oxidant injury.

Concealed mothball abuse prior to anesthesia: mothballs, inhalants, and their management

Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment, and, in rare cases, cardiac dysrhythmias and deranged end-tidal gas monitoring. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. We present a case of a young adult who initially concealed her chronic mothball inhalation. The literature regarding mothball abuse as well as inhalant abuse relevant to anesthesia is reviewed, and suggestions for the diagnosis and peri-operative management are offered.

Naphthalene exposure: Effects on gene expression and proliferation in human cord blood cells

In this study, the effect of naphthalene on the induction of apoptosis and gene expression profiles in cord blood cells has been evaluated, as well as its activity on the BCL-2 related protein expression. After 6, 24, and 48 h of exposure to naphthalene (500 microM), a decrease in cell death was observed: the cells became more resistant to the toxicant and capable of surviving after the treatment. A Western blot analysis revealed an overexpression of BCL-2, c-JUN, c-FOS, and RAF-1 proteins, which are involved in the antiapoptotic response and in the regulation of cell growth, differentiation, and development. Furthermore, macroarray analysis showed that naphthalene modified cord blood gene expression, inducing IL-8 precursor and T-cell transcription factor and decreasing the level of RNA-binding protein FUS/TLS.

Pelvic pain, low blood pressure, and hemolysis after outpatient hysteroscopy in a patient with glucose-6-phosphate dehydrogenase deficiency

OBJECTIVE

To report hemolytic crisis in a woman with glucose-6-phosphate dehydrogenase (G6PD) deficiency who underwent diagnostic hysteroscopy using endoscopic instruments sterilized in gluteraldehyde and phenol disinfectant.

DESIGN

Case report.

SETTING

Surgical unit of a university hospital.

PATIENT(S)

A 53 year-old woman with endometrial thickening on ultrasonography.

INTERVENTION(S)

Diagnostic hysteroscopy.

MAIN OUTCOME MEASURES

Laboratory tests.

RESULT(S)

The patient experienced abdominal pain and acute hypotension 10 minutes after diagnostic hysteroscopy. We attributed this event to the exposure of her genital mucosa caused by the hysteroscopic chemical disinfectant.

CONCLUSION(S)

Chemical sterilization of endoscopes can cause clinical manifestations in people with G6PD deficiency, a common enzyme abnormality. The phenol content in some chemical disinfectants for endoscopic instruments can also cause hemolytic crisis.

Haemolytic anaemia after oral self-giving of naphthalene-containing oil

A clinical case of suicide attempt by means of oral self-giving of naphthalene-containing oil in an old man was reported. Clinical features showed haemolytic anaemia supported by a decrease of haemoglobin concentration and red blood cell count, an increase of bilirubin (prevalently indirect) and lactate dehydrogenase and very low levels of haptoglobin. Methaemoglobin (metHb) measured at admission to the Emergency Room and 19 days after poisoning was still above normal limits. No deficiency of glucose-6-phosphate dehydrogenase was detected. The clinical manifestations ameliorated after treatment with concentrated red blood cells and ascorbic acid, with fast normalization of metHb. The clinical picture appeared almost normal 1 month after poisoning. The clinical diagnosis was 'haemolytic anaemia caused by naphthalene'. Absence of glucose-6-phosphate dehydrogenase deficiency probably reduced the severity of poisoning.

Hereditary red blood cell disorders in middle eastern patients

Hereditary disorders of erythrocytes are common in many areas of the world, including the Middle East. In some regions of the Middle East more than 10% of the population are carriers of a gene for one of these conditions. When patients from the Middle East seek medical care in the West, an unrecognized but clinically important erythrocyte disorder can result in serious complications during routine medical care, such as a drug-induced hemolytic crisis. This article reviews the most important and most common inherited red blood cell disorders in Middle Eastern patients, including glucose-6-phosphate dehydrogenase deficiency, the thalassemias, and sickle cell disorders. We discuss when to suspect such conditions, how to determine their presence, and how to avoid potential complications related to them. Although a detailed discussion of treatment of erythrocyte disorders is beyond the scope of this article, some general management principles are described.