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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 3  |  Page : 667-668
Henna leaf ingestion and intravascular hemolysis: the missing link


1 Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, Salem, Tamil Nadu, India
2 Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, India
3 Department of Forensic Medicine and Toxicology, ESIC-Medical College and PGIMSR, Bangalore, India
4 Department of Internal Medicine, Chennai Medical College and Research Center, Irungalur, Trichy, India

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Date of Web Publication9-May-2014
 

How to cite this article:
Senthilkumaran S, David SS, Menezes RG, Thirumalaikolundusubramanian P. Henna leaf ingestion and intravascular hemolysis: the missing link. Saudi J Kidney Dis Transpl 2014;25:667-8

How to cite this URL:
Senthilkumaran S, David SS, Menezes RG, Thirumalaikolundusubramanian P. Henna leaf ingestion and intravascular hemolysis: the missing link. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 15];25:667-8. Available from: http://www.sjkdt.org/text.asp?2014/25/3/667/132232
To the Editor ,

The case report by Qurashi et al was indeed interesting. [1] However, we wish to highlight certain aspects of the clinical, phytochemical and educational perspectives from the toxicological point of view. Although the authors have speculated Para-phenylenediamine (PPD) as the primary offender for the clinical manifestations observed, they do not match the toxidrome of PPD. [2] The pathognomonic toxidrome of PPD ingestion is severe cervico-facial edema and rhabdomyolysis, which manifests itself as chocolate-colored urine. The contention regarding the absence of cervico-facial edema is acceptable due to its dose-dependent variability, but the authors have not mentioned any clinical or laboratory evidence for rhabdomyolysis in this patient.

Henna (Lawsonia alba) bears the active ingredient lawsone (2-hydroxy-1,4-naphthoquinone), which has the structure and redox potential similar to that of ortho-substituted 1, 4-naphthoquinones, which are known to induce oxidative injury within red cells. [3] The extensive use of henna without adverse effects indicates that it is safe for external application. However, there were many case reports of hemolytic crises following external application of henna in G6PD-deficient individuals. [4],[5],[6] Current scientific evidence suggests that lawsone is a directly acting hemolytic agent that induces oxidative stress, and is thus consistent with the clinical observation of enhanced sus-ceptibility to henna in G6PD-deficient individuals.

Zinkam et al [4] had observed increased oxidative hemolysis and hyper-bilirubinemia in G6PD-deficient patients. Interestingly, Raupp et al [5] reported hemolytic crisis in four G6PD-deficient children after topical application of henna in the United Arab Emirates. Retrospectively, estimation of G6PD concentration in this patient could have helped to exclude the association between henna and hemolysis, as the incidence of G6PD deficiency is well documented in the Middle East. [7] Also, it would be valuable to study the reticulocyte count, lactate dehydrogenase level and myoglobin level in this patient. Based on the available data, it is justified to consider henna leaf to be the primary offender of acute kidney injury due to hemolysis, rather than PPD.

 
   References Top

1.Qurashi HE, Qumqumji AA, Zacharia Y. Acute renal failure and intravascular hemolysis following henna ingestion. Saudi J Kidney Dis Transpl 2013;24:553-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Sampathkumar K, Yesudas S. Hair dye poisoning and the developing world. J Emerg Trauma Shock 2009;2:129-31.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.McMillan DC, Sarvate SD, Oatis JE, Jollow DJ. Role of Oxidant Stress in Lawsone-Induced Hemolytic Anemia. Toxicol Sci 2004; 82:647-55.  Back to cited text no. 3
    
4.Zinkham WH, Oski FA. Henna: A potential cause of oxidative hemolysis and neonatal hyper-bilirubinemia. Pediatrics 1996;97:707-9.  Back to cited text no. 4
    
5.Raupp P, Hassan JA, Varughese M, Kristiansson B. Henna causes life threatening hemolysis in glucose - 6 - phosphate dehydrogenase deficiency. Arch Dis Child 2001;85:411-2.  Back to cited text no. 5
    
6.Kok AN, Ertekin MV, Ertekin V, Avci B. Henna (Lawsonia inermis Linn.) induced haemolytic anaemia in siblings. Int J Clin Pract 2004;58:530-2.  Back to cited text no. 6
    
7.Warsy AS, El-Hazmi MA. G6PD deficiency, distribution and variants in Saudi Arabia: An overview. Ann Saudi Med 2001;21:174-7.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Subramanian Senthilkumaran
Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, Salem, Tamil Nadu
India
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DOI: 10.4103/1319-2442.132232

PMID: 24821174

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