Henna (Lawsonia inermis Linn.) inducing haemolysis among G6PD-deficient newborns. A new clinical observation

Abstract

Over a 10-year period, 15 glucose-6-phosphate dehydrogenase (G6PD)-deficient male newborns were admitted to Al-Jahra Hospital with acute haemolysis a few days after applying henna dye over the body, which is a unique Bedouin tribal practice to celebrate the arrival of the first-born boy. Laboratory investigations revealed significant anaemia, reticulocytosis and indirect hyperbilirubinaemia among the index newborns as compared with controls (p < 0.001). The mean (SD) haemoglobin concentration in index patients was 113.4 (13.4) g/l vs 171.2 (11.2) g/l in controls, reticulocytic count 13.8% (4.2%) vs 1.4% (0.74%), and indirect bilirubin 382.8 (58.7) mumol/l vs 63.7 (61.4) mumol/l. G6PD-deficient newborns with haemolysis linked to henna application had delayed age at presentation and a higher reticulocytic count and hyperbilirubinaemia compared with non-henna-induced haemolysis (p < 0.05). Percutaneous henna absorption is well recognized and clinical findings support the harmful effect of henna on G6PD-deficient red blood cells. A local health education programme has been established to prevent the use of henna dye in infancy.

Pro-oxidative effects of tea and polyphenols, epigallocatechin-3-gallate and epigallocatechin, on G6PD-deficient erythrocytes in vitro

“…G6PD-deficient subjects are vulnerable to oxidative stress. This predisposes them to chemical-induced hemolysis, if exposed to pro-oxidative agents such as fava bean (3,4), mothball (5,6), henna (7,8), anti-malarial drugs (9,10), and a variety of herbs (11)(12)(13)(14).…”

Plasma exchange as treatment for Lawsone (henna) intoxication

“…Although our patient of north Iraqi origin was unaware of having G6PD deficiency, this deficiency is quite common, in particular, in north Iraqi males [8]. The severity of this patient's symptoms relative to the small amount ingested would suggest extreme sensitivity as may be seen with G6PD individuals exposed to Lawsone [4][5][6]. We were unable to perform testing for G6PD deficiency in view of the severe hemolysis which occurred, which does not allow accurate enzyme quantitation since in this syndrome, the most deficient red cells are those which hemolyze.…”

“…Lawsone toxicity is believed to be more severe in individuals with G6PD deficiency [4][5][6], owing to the oxidative damage to the red blood cells which results from Lawsone [7]. Although our patient of north Iraqi origin was unaware of having G6PD deficiency, this deficiency is quite common, in particular, in north Iraqi males [8].…”

Topical henna for capecitabine induced hand–foot syndrome

“…It is used in eastern cultures and also in rural areas of Turkey. It was applied in herbal topical medicine for the treatment of seborrhoea or fungal infections and used as a traditional dye for hair, nails, scalp and for other decorative body paintings [8]. So far antioxidant and immunomodulatory effects are shown in rats [9].…”