{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T18:06:41Z","timestamp":1779473201067,"version":"3.53.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dapsone is used in many infectious and immunological diseases. Dapsone may cause haemolysis, particularly in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This hemolysis is described as oxidative and is usually not associated with the presence of schistocytes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We conducted a single-centre retrospective observational study at the University Hospital of Tours, France (2005\u20132021). Adult patients who received dapsone and had a blood smear performed during treatment or within 7 days of discontinuation were included. Data were extracted from electronic medical records. Patients were classified as schistocyte-positive (\u22650.1%) or -negative. Descriptive statistics were used; no further analyses were performed due to small sample size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 2005\u22122021 period, 19 adult patients received dapsone in our institution. Amongst them, 10 (52.6%) had detectable schistocytes, ranging from 2 to 44\/1000 erythrocytes (13\u2009\u00b1\u200914.2). Patients with schistocytosis exhibited more severe hemolytic anemia, with a larger decrease in hemoglobin (\u22122.7\u2009\u00b1\u20091.4\u2009g\/dL vs \u22121.6\u2009\u00b1\u20092.12\u2009g\/dL), higher methemoglobinemia (5.2% vs 1.9%), more frequent low haptoglobin levels (88.9% vs 60%), and elevated LDH levels (557 U\/L [239\u2013671] vs 273 U\/L [208\u2013507]) compared to patients without schistocytosis. Platelet counts were similar between the two groups. No organ failure was identified in the reviewed medical records. Schistocytosis regressed upon discontinuation of treatment after 3\u201318 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dapsone appears to be associated with hemolytic anemia and the presence of schistocytes, suggesting mechanical intravascular haemolytic anaemia. Whether Dapsone-associated biological thrombotic microangiopathy can be associated with target organ damage requires further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349570","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T17:41:41Z","timestamp":1779471701000},"page":"e0349570","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dapsone and schistocytes: Thrombotic microangiopathy or not?"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0879-1164","authenticated-orcid":true,"given":"Alexis","family":"Archambeaud","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Aumont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Pouplard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Sarah","family":"Agier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Maillot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Halimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Bigot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"issue":"6596","key":"pone.0349570.ref001","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(50)90257-1","article-title":"Treatment of leprosy with diamino-diphenyl sulphone by mouth","volume":"1","author":"J Lowe","year":"1950","journal-title":"Lancet"},{"issue":"2","key":"pone.0349570.ref002","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1001\/archinte.1967.00300020114017","article-title":"A review of therapeutic and hemolytic effects of dapsone","volume":"120","author":"RL DeGowin","year":"1967","journal-title":"Arch Intern Med"},{"issue":"4","key":"pone.0349570.ref003","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/j.1365-2133.1970.tb06829.x","article-title":"Anaemia in dermatitis herpetiformis. The role of dapsone-induced haemolysis and malabsorption","volume":"82","author":"JJ Cream","year":"1970","journal-title":"Br J Dermatol"},{"issue":"12","key":"pone.0349570.ref004","first-page":"1025","article-title":"Methemoglobinemia and hemolytic anemia induced by Disulon","volume":"109","author":"Y De Prost","year":"1982","journal-title":"Ann Dermatol Venereol"},{"key":"pone.0349570.ref005","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3109\/03602539509029818","article-title":"Dapsone-induced hemolytic anemia","volume":"27","author":"DJ Jollow","year":"1995","journal-title":"Drug Metab Rev"},{"issue":"6","key":"pone.0349570.ref006","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S0248-8663(89)80071-2","article-title":"Effets h\u00e9matologiques de la dapsone (Disulone\u00ae)","volume":"10","author":"D Bordessoule","year":"1989","journal-title":"Rev M\u00e9d Interne"},{"issue":"1","key":"pone.0349570.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1001\/archderm.1985.01660010029009","article-title":"Dapsone and Heinz bodies","volume":"121","author":"MH Rosove","year":"1985","journal-title":"Arch Dermatol"},{"issue":"5122","key":"pone.0349570.ref008","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1136\/bmj.1.5122.625","article-title":"Heinz-body anaemia due to dapsone","volume":"1","author":"RS Smith","year":"1959","journal-title":"Br Med J"},{"issue":"1","key":"pone.0349570.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0085712","article-title":"Clinical oxidative stress during leprosy multidrug therapy: impact of dapsone oxidation","volume":"9","author":"TR Schalcher","year":"2014","journal-title":"PLoS One"},{"key":"pone.0349570.ref010","doi-asserted-by":"crossref","DOI":"10.1093\/neuonc\/nov226.10","article-title":"Increased risk for hemolytic anemia in glioblastoma patients treated with dapsone","volume":"17","author":"P Oppelt","year":"2015","journal-title":"Neuro Oncol"},{"issue":"6","key":"pone.0349570.ref011","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/neuonc\/noaa026","article-title":"Hemolytic anemia associated with dapsone PCP prophylaxis in GBM patients with normal G6PD activity","volume":"22","author":"LR Rogers","year":"2020","journal-title":"Neuro Oncol"},{"issue":"11","key":"pone.0349570.ref012","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/j.healun.2008.07.025","article-title":"Dapsone-induced hemolytic anemia in lung allograft recipients","volume":"27","author":"PM Naik","year":"2008","journal-title":"J Heart Lung Transplant"},{"issue":"4","key":"pone.0349570.ref013","first-page":"225","article-title":"Perte brutale de vision cons\u00e9cutive \u00e0 une meth\u00e9moglobin\u00e9mie induite par la dapsone","volume":"26","author":"D Hanuschk","year":"2014","journal-title":"Toxicol Anal Clin"},{"issue":"3","key":"pone.0349570.ref014","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2146\/ajhp160961","article-title":"Review and drug therapy implications of glucose-6-phosphate dehydrogenase deficiency","volume":"75","author":"KD Belfield","year":"2018","journal-title":"Am J Health Syst Pharm"},{"issue":"7","key":"pone.0349570.ref015","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of thrombotic microangiopathy","volume":"371","author":"JN George","year":"2014","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0349570.ref016","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/j.ekir.2025.04.051","article-title":"Toward a revised definition of thrombotic microangiopathy","volume":"10","author":"SAMEG Timmermans","year":"2025","journal-title":"Kidney Int Rep"},{"issue":"6","key":"pone.0349570.ref017","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1016\/j.ekir.2025.03.019","article-title":"Diagnostic value of biological parameters in biopsy-confirmed thrombotic microangiopathy-MATRIX consortium group","volume":"10","author":"J-M Halimi","year":"2025","journal-title":"Kidney Int Rep"},{"key":"pone.0349570.ref018","doi-asserted-by":"crossref","first-page":"1088031","DOI":"10.3389\/fphar.2022.1088031","article-title":"Drug-induced thrombotic microangiopathy: an updated review of causative drugs, pathophysiology, and management","volume":"13","author":"T Mazzierli","year":"2023","journal-title":"Front Pharmacol"},{"issue":"11","key":"pone.0349570.ref019","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1111\/j.1600-6143.2005.01079.x","article-title":"Complications related to dapsone use for Pneumocystis jirovecii pneumonia prophylaxis in solid organ transplant recipients","volume":"5","author":"I Lee","year":"2005","journal-title":"Am J Transplant"},{"issue":"3","key":"pone.0349570.ref020","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1038\/bmt.2011.83","article-title":"High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency","volume":"47","author":"H Olteanu","year":"2012","journal-title":"Bone Marrow Transplant"},{"issue":"21","key":"pone.0349570.ref021","doi-asserted-by":"crossref","first-page":"6378","DOI":"10.3390\/jcm11216378","article-title":"Dapsone-associated anemia in heart transplant recipients with normal glucose-6-phosphate dehydrogenase activity","volume":"11","author":"KW Lor","year":"2022","journal-title":"JCM"},{"key":"pone.0349570.ref022","article-title":"Confused about the hypoxia: a case of dapsone-induced methemoglobinemia","volume":"24","author":"H Hazani","year":"2020","journal-title":"Proc UCLA Health"},{"issue":"6","key":"pone.0349570.ref023","first-page":"412","article-title":"Dapsone-induced hemolytic anemia in a patient with relapsing polychondritis","volume":"14","author":"E Waller","year":"1980","journal-title":"Drug Intell Clin Pharm"},{"issue":"11","key":"pone.0349570.ref024","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1309\/LMK7OA1GYP3SRDBD","article-title":"Unexpected cause of anemia in a 45-year-old patient with acute lymphoblastic leukemia","volume":"41","author":"A Pendse","year":"2010","journal-title":"Lab Med"},{"issue":"1","key":"pone.0349570.ref025","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1080\/16078454.2022.2149943","article-title":"Dapsone-induced methemoglobinemia and hemolysis in a woman without G6PD deficiency presenting with idiopathic urticaria","volume":"27","author":"Y Hu","year":"2022","journal-title":"Hematology"},{"issue":"23","key":"pone.0349570.ref026","doi-asserted-by":"crossref","first-page":"4540","DOI":"10.1182\/blood.V126.23.4540.4540","article-title":"Evaluation of normal reference range of schistocytes and burr cells in healthy adults","volume":"126","author":"M Ahmed","year":"2015","journal-title":"Blood"},{"issue":"1","key":"pone.0349570.ref027","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/ajh.10450","article-title":"Morphologic diagnosis of thrombotic thrombocytopenic purpura","volume":"75","author":"ER Burns","year":"2004","journal-title":"Am J Hematol"},{"issue":"9","key":"pone.0349570.ref028","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1345\/aph.1Q139","article-title":"Dapsone-induced methemoglobinemia: a primer for clinicians","volume":"45","author":"JA Barclay","year":"2011","journal-title":"Ann Pharmacother"},{"issue":"6","key":"pone.0349570.ref029","doi-asserted-by":"crossref","first-page":"516","DOI":"10.3109\/15563650.2010.490534","article-title":"Dapsone intoxication: clinical course and characteristics","volume":"48","author":"KH Park","year":"2010","journal-title":"Clin Toxicol (Phila)"},{"issue":"1","key":"pone.0349570.ref030","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/S0022-3565(25)24263-X","article-title":"Role of dapsone hydroxylamine in dapsone-induced hemolytic anemia","volume":"244","author":"SJ Grossman","year":"1988","journal-title":"J Pharmacol Exp Ther"},{"issue":"3","key":"pone.0349570.ref031","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1002\/jat.1493","article-title":"Cytochrome P450-dependent toxicity of dapsone in human erythrocytes","volume":"30","author":"S Ganesan","year":"2010","journal-title":"J Appl Toxicol"},{"issue":"2","key":"pone.0349570.ref032","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/toxsci\/kfz188","article-title":"Dapsone hydroxylamine, an active metabolite of dapsone, can promote the procoagulant activity of red blood cells and thrombosis","volume":"172","author":"Y Bian","year":"2019","journal-title":"Toxicol Sci"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349570","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T17:41:46Z","timestamp":1779471706000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349570"}},"subtitle":[],"editor":[{"given":"Taj Muhammad Jahangir","family":"Khuhawar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349570","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}