Studies on erthrocytes in cases with past history of favism and drug-induced acute hemolytic anemia.

By A. SZEINBERG, C. SHEBA, NINA HIRSHORN AND EVA B0D0NYI M OST acquired hemolytic anemias (with the exception of acquired idiopathic hemolytic anemia, incotnpatihle blood transfusions and Rh senzitization) and all cases of thalassemia show in this country a well defined ethnographic distribution. Only Jews originating from oriental and Mediterranean countries who have a da.rker consplexion and are called Sephardic ,Jews in contrast to the light complexioned Ashkenazic Jews from eastern, central and western Europe are victims of such hemolytic occurrences.1 Gross blood destruction is encountered in some individuals or families of this population group after ingestion of fava beans or various drugs (e.g., sulpha drugs, plasmoquine, para-ansino-salicylic acid) as well as following some iisfectious diseases (e.g., typhoid). Such distribution of susceptibility suggested t.hat some common constitutional factor must be connect-ed wit-h the pathogenesis of these disorders and that such a factor could give rise to hemolysis only aft-er exposure to au external agent (for instance sulpha drugs or fava beans) iso matter what. the age of the victim be at the time of such exposure. To illustrate t.his, a case of favism in a 74 year old Persian Jew is reported in brief. This was his first hemolyt-ic crisis and followed the iusgestion of fava beans. In his country and dist.rict of origin Vicia faba was apparently not grown and as he arrived to this country only three years ago, exposure could have taken place in the suit-able season (spring) only since then. He developed an acute heniolyt.ic episode and on adtnission showed less than one million RBCs. He recovered aft-er blood transfusions. Another case illustrating the same is that of a 57 year old woman, who immigrated from Iraq; there she never ate fava beans. In this country, during the first (or t.he second) spring season she noticed extreme fatigue and red tinged urine, which she interpreted as menstrual flow. ‘When in the following spring she came down with severe hemolysis and very red colored urine she again blamed the Holy Land for its known miraculous effect on old women (allusion to Sarah, Wife of Abraham) and it was our task to dispel her misinterpretation of what was actually hemoglobinuria after ingest-ion of Vicia faba. It was known already in Roman times that. among the Mediterraneans certain families show a tendency to hensolysis after ingestion of fava beans, as the wellknown sentence “Pyt.hagorei faba se abst.inuerunt.” possibly implies. To illustrate this familial occurrence we mention from our material a Yemenite family in which one brother suffered 1)0th from favism and from hemoglobinuria after sulphapyridine, a second from favism and a third brother from hemoglo-