SHM Converge Scientific Abstract ePoster Gallery-The Hidden Risk of a Greek Physique: Strength at a Cellular Cost

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This case describes a 21-year-old man admitted with <strong>severe hemolytic anemia</strong> and jaundice, ultimately felt to be <strong>zinc-induced autoimmune hemolytic anemia</strong>. He had no significant past medical, surgical, family, or social history, and denied tobacco, alcohol, and illicit drug use. His only regular medication was acetaminophen, but he was taking a large number of workout and sexual performance supplements, including <strong>zinc oxide 340 mg daily</strong>, along with products such as ginseng, ashwagandha, fenugreek, rhodiola, tribulus, mucuna, horny goat weed, guarana, and others.

On presentation, he was hemodynamically stable but appeared ill with <strong>stupor, jaundice, and scleral icterus</strong>. Lung exam showed rhonchi, while cardiac and abdominal exams were otherwise unremarkable.

Laboratory findings were consistent with <strong>marked hemolysis and anemia</strong>: hemoglobin 9.5 g/dL, elevated bilirubin (total 8.2, indirect 7.3), very high LDH (3,612), low haptoglobin (10), and a <strong>positive direct antiglobulin test (DAT) for IgG</strong>. Liver enzymes were mildly elevated. Peripheral smear showed no blasts, and bone marrow/flow cytometry workup did not reveal leukemia or another malignant process. Extensive testing, including ANA, dsDNA, CT chest/abdomen/pelvis, and genetic studies, was unrevealing. Evaluation for autoimmune lymphoproliferative syndrome showed normal immunoglobulins, normal complement levels, and only a small TCR alpha-beta double-negative T-cell population.

Overall, the workup excluded common causes of hemolysis and supported a diagnosis of <strong>drug/supplement-associated autoimmune hemolytic anemia</strong>, with <strong>excess zinc supplementation</strong> considered the key trigger. The case highlights the hidden dangers of over-the-counter bodybuilding and performance supplements, even in young healthy adults.

Asset Subtitle

Benjamin I. Isaac

Meta Tag

Author List Benjamin I. Isaac, Sourav Bansal

Category Clinical Vignettes

Concept Hemolytic Anemia

Concept Autoimmune Hemolytic Anemia

Concept Hemolysis Marker

Concept Direct Antiglobulin Test

Concept Jaundice

Distinguished Non-Finalist

Presenter Organization MercyOne Des Moines Medical Center Internal Medicine Residency

Presenting Author Benjamin I. Isaac

Track Adult

Keywords

zinc-induced autoimmune hemolytic anemia

severe hemolytic anemia

jaundice

direct antiglobulin test

zinc oxide supplementation

drug-induced hemolysis

supplement-associated anemia

elevated LDH

low haptoglobin

bodybuilding supplements

Hemolytic Anemia

Autoimmune Hemolytic Anemia

Hemolysis Marker

Direct Antiglobulin Test

Jaundice