Diphenylhydantoin-Induced Hemolytic Anemia and Acute Renal Failure

Abstract

Although various side effects of diphenylhydantoin have been reported, there are few case reports of diphenylhydantoin induced hemolytic anemia. A 54-years-old female, who had received 100-170 mg diphenylhydantoin for eight weeks, was presented with oliguria and dark urine. The findings : transient anemia with marked reticulocytosis, increased lactic dehydrogenase activity, decreased haptoglobin levels, and hemoglobinuria ; were indicative of hemolytic anemia although direct and indirect Coomb's test was consistently negative. The evidnces of hemolysis disappeared spontaneously four to six weeks after discontinuation of diphenylhydantoin administration and there has been no recurrence of hemolysis during a two years follow-up period. These facts lead us to suggest that this was a case of diphenylhydantoin induced hemolytic anemia.