Severe aplastic anaemia following the use of hair dye: report of two cases and review of literature

Abstract

Summary:We describe two female patients aged 31 and 62 y who developed severe aplastic anaemia following the use of hair dye containing para-toluenediamine. One received a bone marrow transplant but died after developing graft versus host disease and severe opportunistic infection. The second responded to treatment with methylprednisolone, oxymetholone and antithymocyte globulin and 3 y later she has a normal blood count apart from mild thrombocytopenia.In this paper we also review previously described case reports of aplastic anaemia apparently associated with the use of hair dye.

Paraphenylene diamine exacerbates platelet aggregation and thrombus formation in response to a low dose of collagen

“…A normal human platelet count ranges from 150,000 to 400,000 per microliter of blood. The exact mechanisms involved in thrombocytopenia due to PPD has not been studied or reported but appears to be the combination of direct toxic effect to platelets leading to their accelerated killing and effect on bone marrow leading to ineffective or suppressed production (Burnett et al, 1977;Hopkins and Manoharan, 1985). To this end we first evaluated in vitro the effect of PPD on human platelets and then we investigated to assess its effect on platelets and formation of pulmonary micro-emboli in rat in response to collagen.…”

Final Amended Report of the Safety Assessment of Toluene-2,5-Diamine, Toluene-2,5-Diamine Sulfate, and Toluene-3,4-Diamine as Used in Cosmetics

“…The authors of this case report noted that although it is difficult to prove that toluene-2,5-diamine was the etiological factor of the anemia cases, no other cause could be found. 98…”

Systemic toxicity of paraphenylenediamine

“…Rare complications of PPD toxicity that are reported include chronic renal failure, severe myocardial rhabdomyolysis leading to cardiogenic shock and death, severe aplastic anemia, severe contact dermatitis and optic atrophy. [8][9][10][11][12][13] Sudden cardiac death observed in 2 patients could be related to severe myocardial rhabdomyolysis, as reported earlier. [9,10] There is no specific antidote for PPD and treatment is supportive.…”