Drug Heinz bodies

Oxidized, denatured hemoglobin forms aggregates, which can become attached to the inner surface of the red cell, known as Heinz bodies. This leads to damage to the red cell, which may result in direct destruction of the cell, which can be shown in vitro, or removal from the circulation by the spleen in vivo. When caused by Fava beans, the syndrome is known as Favism. As the deficient enzyme (glucose-6-phosphate dehydrogenase) is intrinsic to the red cell, exposure of such cells in vitro to suitable drugs will lead to cell damage and death. 

Sabine, represent spontaneous mutations. The effect of the substitution can be extremely mild (Hb-Richmond, Hb-I-Toulouse) to severe (Hb-Bibba, Hb-Hammersmith). Subjects with Hb-Zurich are asymptomatic unless exposed to oxidant drugs causing an acute hemolytic episode with formation of Heinz bodies. Particularly severe is the lesion in Hb-Hammersmith because the removal of phenylalanine GDI is accompanied by the introduction of the polar OH group of serine which probably facilitates the entry of water into the heme pocket which causes the heme group to drop out (P14). Substitution of this phenylalanine by leucine, as in Hb-Louisville, results in a much less severe anemia (K9). 

Ohno H,Tojo H, Kakihata K, Nomura M,Takayama S. Heinz body hemolytic anemia induced by DQ-2511, a new anti-ulcer drug, in dogs. Fundam Appl Toxicol 1993 20(2) 141-146. 

Some of the abnormal haemoglobins are unstable. This lability is often associated with chronic haemolytic anaemia and inclusions (Heinz bodies) formation after splenectomy. Drug-induced haemolytic episodes have been observed in individuals with one of the three unstable haemoglobins Hb Zurich, Hb Torino, and HbH. 

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