Medical Laboratory Osnabrueck, Georgsmarienhuette, Germany.
Institute of Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany.
Scand J Clin Lab Invest. 2021 Feb;81(1):8-11. doi: 10.1080/00365513.2020.1855468. Epub 2020 Dec 21.
After intravenous supplementation of an unintentionally high dose of the antioxidant alpha-lipoic acid (ALA), a 53-year-old female complained of myalgia, chills and nausea, and showed signs of haemorrhagic diathesis. The laboratory findings were excessive hyperferritinemia, leukoerythroblastosis, severe thrombocytopenia, elevated liver enzymes and impaired coagulation. The toxicological tests resulted in an ALA serum concentration of 10 280 µg/L. The peripheral blood film of the patient showed some neutrophil dysplasia with unusual small dark-blue stained round cytoplasmic inclusions resembling 'Howell-Jolly-body-like' (HJBL) cytoplasmic inclusions, aptly named due to the morphologic similarity to their erythrocytic counterparts. Such HJBL inclusions are occasionally associated with acquired immunodeficiency, or immunosuppressive or cytostatic treatment. An association with ALA intoxication has not been described before. There are only a few reports on unintentional, harmful and lethal intoxications with ALA. The underlying molecular background of its toxicity on liver function or haematopoiesis is not yet known in detail, but ALA seems to interact with enzyme functions, e.g. with mitochondrial enzyme-complexes, possibly due to its pro-oxidant potential at high doses.
一位 53 岁女性在意外静脉补充高剂量抗氧化剂 α-硫辛酸 (ALA) 后，主诉肌痛、寒战和恶心，并出现出血倾向迹象。实验室检查结果显示：铁蛋白过多、白细胞红细胞前体细胞增多、严重血小板减少、肝酶升高和凝血功能受损。毒理学检测显示患者血清 ALA 浓度为 10,280µg/L。患者外周血涂片显示一些中性粒细胞发育不良，有不寻常的小暗蓝色染色圆形细胞质内含物，类似于“豪周氏小体样”（HJBL）细胞质内含物，因其与红细胞的形态相似而得名。这种 HJBL 内含物偶尔与获得性免疫缺陷、免疫抑制或细胞毒治疗有关。以前没有描述过与 ALA 中毒有关的情况。只有少数关于意外、有害和致命的 ALA 中毒的报告。其对肝功能或造血功能的毒性的潜在分子机制尚不清楚，但 ALA 似乎与酶功能相互作用，例如与线粒体酶复合物相互作用，这可能是由于其在高剂量下具有促氧化剂潜能。
