Intravascular Hemolytic Anemia with Acanthocytosis Following Alternative Treatment with Ozone, UV Light, and Perflurocarbon

Abstract

Alternative medicine has become more common as patients seek approaches to diseases where traditional medicine has failed. Treatment with ozone has been purported to have benefits for a variety of infectious, inflammatory and neoplastic conditions. Treatment can be administered by the intra arterial, intravenous, intra rectal and subcutaneous routes as well as ozonated autohaemotherapy. We describe a 44 year old woman who received treatment at an alternative medical center for recurrent breast cancer including laetrile, perflurocarbon emulsion, high dose ascorbic acid, vitamin K and extracorporeal treatment of her blood with ozone and ultraviolet light. After receiving her second treatment, she presented to our hospital with a syncopal episode and was found to be anemic (Hb 4 gm/dl). The LDH was 8X> ULN, the serum haptoglobin was undetectable, and the reticulocyte count was increased. The peripheral blood smear showed aniscocytosis, poikilocytosis and polychromasia. There was also severe acanthocytosis. Heinz bodies were not detected. The patient refused blood products and after 48h of hospitalization, her Hb rose to 7gm and she was discharged. She did not return for follow-up evaluation. Acanthocytosis has been associated with impairment of cholesterol membrane fluidity seen with acquired hepatic disease as well as some congenital diseases. Oxidative stress can lead to peroxidation of membrane phospholipids, and if the intrinsic repair mechanism of the RBC is overwhelmed, the RBCs transform into acanthocytes. To date, there has been no literature describing hemolysis associated with any of the individual treatments which this patient received; however the combination of treatments exposed the RBC’s to multiple oxidative stresses which might lead to lipid peroxidation and formation of acanthocytes. This case illustrates the potential problems that face clinicians when encountering patients who seek alternative therapy.