ACUTE HEMOLYTIC ANEMIA DUE TO INGESTION OF NAPHTHALENE MOTH BALLS

Abstract

Naphthalene moth balls are potent hemolytic agents, capable of producing an acute, severe and perhaps fatal anemia. Moth ball poisoning should be suspected in children manifesting evidence of sudden hemolytic anemia, and an attempt should be made to demonstrate naphthalene or its derivatives in the urine. Care should be taken to prevent moth balls from being reached by infants and children. α- and β-naphthol and α- and β-naphthoquinone were found in the urine of a child suffering from severe hemolytic anemia due to ingestion of naphthalene moth balls. The hemolytic properties of naphthalene, of the naphthols and naphthoquinones were examined in vitro and in vivo (rabbits). Naphthalene itself was found to be nonhemolytic in vitro or in vivo. The hemolytic power of the naphthalene metabolites in vitro decreased in the following order: α-naphthol, β-naphthol, α-naphthoquinone, β-naphthoquinone. Hemolysis due to α-naphthol was observed in vivo (rabbits). However, its hemolytic action was significantly weaker than in vitro. β-naphthol and the naphthoquinones showed no hemolytic activity in vivo (rabbits). Plasma, cholesterol and lecithin did not inhibit the hemolytic activity of the naphthalene metabolites in vitro. Formation of methemoglobin was not observed.