Erythrocyte hemighosts: a hallmark of severe oxidative injury in vivo.

Erythrocyte hemighosts and ghosts were found in five patients: two with severe oxidant haemolysis caused by chemicals or drugs, and three G6PD deficient subjects with haemolysis triggered by infection and/or drugs. Scanning and transmission electron-microscopy showed that the hemighost consisted of a thinned-out part with antero-posterior apposition of the membrane and a thicker spheroidal part containing most of the haemoglobin. Heinz bodies were found in both parts of the cell close to the membrane. Large number of hemighosts (30-90%) is an ominous sign as three of our five affected patients died. The removal of these cells by exchange transfusion or the induction of forced diuresis probably saved the life of the other two patients. Experiments in rabbits showed that hemighosts were found only with severe oxidative injury induced by a large dose of acetylphenylhydrazine (50 mg/kg) and the spleen was not required for their formation. The marked congestion in the splenic sinusoids and other microcirculation results from sludging of these damaged rigid cells and is an important pathophysiological mechanism in severe oxidant injury.