Heinz Body Hemolytic Anemia in Newborns and Failure of Laboratory Studies to Implicate a Phenolic Disinfectant

Abstract

Two unrelated, white, female, premature infants in the same hospital nursery contemporaneously exhibited features of an acute, Heinz body hemolytic anemia: decreased levels of hemoglobin and hematocrit, anisocytosis, fragmented cells, hyperbilirubinemia, reticulocytosis, and red cell inclusion bodies. Physical examination and laboratory studies failed to reveal the etiology of this process. Epidemiologic studies indicated a possible association between the reaction and the improper use and inappropriately high concentration of a phenolic disinfectant. Such an association has been suggested previously between similar products and epidemics of hyperbilirubinemia. Despite extensive experimental efforts (four species, six routes of administration, newborn rats, splenectomized rats, direct incubation with agematched human cord blood), the reaction could not be produced in the laboratory. It may be highly specific for the intact, human, premature infant. Perhaps the hyperbilirubinemia reported previously had an erythrocytic rather than hepatic origin.