HEMOLYTIC-ANEMIA ASSOCIATED WITH INJECTION OF FLUORESCEIN

A 49-year-old woman presented with a hemoglobin level of 9.5 g per dL (95 g/L), reticulocyte count of 6.7 percent (0.067), and hemoglobinuri a. The next day, the hemoglobin had dropped to 5.8 g per dL (58 g/L), and total bilirubin was 8.8 mg per dL (150 mumol/L). The serum reacted 2+ with all red cells (RBCs). The direct antiglobulin test (DAT) was 3+ with anti-IgG and 1+ with anti-C3, but eluates prepared by two diff erent methods did not react with untreated RBCs. The eluate reacted 2 with amoxicillin-coated RBCs; amoxicillin had been listed in the pati ent's record as a previous medication. The patient denied recent inges tion of amoxicillin. Further investigation documented the injection of a dye, fluorescein sodium (AK-FLUOR-25%), for a ophthalmologic fluore scein angiographic study 2 days before admission. RBCs coated with AK- FLUOR reacted with the eluate. Controls consisting of normal serum, an eluate prepared from DAT-negative RBCs, and a serum known to contain anti-penicillin did not react with AK-FLUOR-coated RBCs. Nine days lat er, the DAT was negative and the serum did not react with untreated RB Cs. In the presence of AK-FLUOR (1-in-125) or amoxicillin (1 mg/mL), t he serum reacted 2+ in the antiglobulin test. Antibodies to AK-FLUOR a nd amoxicillin appeared to react by two mechanisms, which is similar t o results in recent reports of other drugs associated with hemolytic a nemia. AK-FLUOR has not previously been reported to be associated with hemolytic anemia.