Autoimmune Hemolytic Anemia Induced By Kangaroo Essence Pills (Report of Two Cases)

The autoimmune hemolytic anemia (AIHA) is characterized by the autoimmune destruction and shortened life span of red blood cells. The kangaroo essence pills (KEP)are marketed worldwide as an aphrodisiac agent. They may contain muscles and genital tissues of Australian kangaroo as the key active components. We report here two cases of autoimmune hemolytic anemia induced by the KEP. Patient One: A 68 years old female presented with malaise, dizziness, jaundice and deep-colored urine for three weeks. Before this, she had taken three brand names of KEP for several weeks. An anemia was diagnosed in a local hospital but the underlying cause was obscure. Treatment with iron, folic acid and mecobalamin was ineffective. Laboratory analysis revealed anemia with a hemoglobin level of 34.4g/L, reticulocyte count of 3.0%, elevated white blood cell count of 22.7×10⁹/L with neutrophiles of 81.4%, and normal platelet count (98.4×10⁹/L). The urine was positive for occult blood, proteinuria (+++), red blood cells (11-15/HP) and bilirubin (++). Total serum bilirubin was 93.3 umol/L and direct bilirubin 69.7umol/L. Both of direct and indirect antiglobulin tests (Coombs' tests) were positive. Cold agglutinins of IgM were negative. Ham’s test was negative. Activity of Glucose-6-phosphate dehydrogenase was normal. Bone marrow morphology showed erythroid hypercellularity, with a predominance of polychromatic normoblasts and orthochromatic normoblasts and abnormality of double-phases. A diagnosis of warm antibody autoimmune hemolytic anemia was made. Intravenous methylprednisolone with a daily dose of 80 mg was administered immediately in addition to transfusion of saline-washed red blood cells. Due to the severity of anemia, three regimens of daily plasmapheresis were given. Clinical conditions were improved rapidly. Two weeks later, the hemoglobin level was returned to normal range and she was discharged. Follow-up for one year proved no evidence of relapse. The patient’s history had no record of allergy and other health problems. The KEP was the only possible cause to induce hemolysis. Besides kangaroo tissues, some KEP may have other addictives such as ginseng, Chinese wolfberry, deers’ sinew, snowdeer’s penis, yak penis, wild donkey penis, cordyceps sinensis, and so on. It is yet known which ingredient, or even some impurities, were the prime culprit in this case. Patient Two: A 25 year old young woman presented with pale and dizziness for a week. CBC test showed decreased hemoglobin level 76.5g/L, reticulocyte count of 4.5%, increased direct bilirubin 48.2 umol/L, and a positive Coombs' test. Two weeks ago she had tried a brand name of KEP as analeptic agent. She was diagnosed with autoimmune hemolytic anemia and immediately cured with oral methylprednisolone. To our knowledge, the AIHA induced directly by “kangaroo essence pills” has yet been reported. It is suggested that caution should be made to take aphrodisiacs of unknown ingredients.