Effect of Dapsone on Red Cell Indices in Patients with Leprosy

BACKGROUND: Hemolysis is one of the chief side-effects of dapsone. But the frequency and severity of hemolysis have not been fully elucidated in patients with leprosy. OBJECTIVE: The purpose of our study was to determine the effect of dapsone on hematologic profile in patients with leprosy. METHODS: We did a retrospective analysis of the effect of daily dapsone(100mg/day) in 26 newly-registered cases undergoing multi-drug therapy. Complete blood count(CBC) was performed on their initial visit and at intervals between one and six months. In 10 cases, glucose-6-phosphate dehydrogenase(G-6-PD) levels were determined and in 12 cases iron study was performed. RESULTS: 1. The average hemoglobin was found to fall by 2.9+/-1.4g/dl, from 13.2+/-1.5g/dl, to a nadir of 10.5+/-1.5g/dl(p<0.01). 2. In 13 cases in whom red cell profiles were available, there was a hemoglobin fall from 12.8+/-1.5g/dl to 10.8+/-1.7g/dl(p<0.01) and a hematocrit fall from 37.0+/-4.6% to 32.9+/-4.8%(p<0.05). There was a increase in mean corpuscular volume(MCV) from 90.7+/-2.9fl to 95.2+/-2.8fl(p<0.01). The mean corpuscular hemoglobin(MCH) and mean corpuscular hemoglobin concentration(MCHC) changed from 31.3+/-2.3pg/cell to 31.2+/-1.4pg/cell(p<0.05) and from 34.6+/-2.2g/dl to 32.9+/-0.7g/dl(p<0.05), respectively. 3. Ten patients had G-6-PD measured and nine had normal levels. One with a low G-6-PD had a relatively dramatic hemoglobin fall. 4. Serum iron studies in 12 cases revealed reduced serum iron in 6 cases but normal or increased ferritin in all cases and decreased total iron binding capacity(TIBC) in 6 cases. CONCLUSION: After dapsone treatment almost all patients had a fall in their hemoglobin concentration and an increase in MCV. Impaired iron utilization was a common finding and deficiency of G-6-PD may be a factor aggravating the hemolytic effect of dapsone in leprosy patients.