Association of Naphthalene with Acute Hemolytic Anemia

: Objectives: To describe the prevalence and severity of naphthalene-associated hemolysis (NAH) and infection-associated hemolysis (IAH) in children with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. To survey the rationale for naphthalene-containing moth repellent (mothball) use in the study population and to compare this with that of a more diverse population. Methods: A ten-year retrospective chart review of 160 patients with G-6-PD deficiency and/or anemia and an analysis of 24 hospitalized African-American children with an episode of acute hemolysis associated with G-6-PD deficiency were conducted. The parents of 330 children cared for in the pediatric emergency departments (EDs) of two tertiary care centers were questioned regarding domestic mothball (naphthalene) use. Results: Fourteen of 24 (58.3%) of the children identified with G-6-PD deficiency presented with hemolysis associated with exposure to naphthalene-containing moth repellents. The remaining ten had IAH. Seventy-nine percent of the NAH group required transfusion, compared with 60% of the IAH group. Mothballs were reportedly used by 27% of the families surveyed in one inner-city population with a 2-13% incidence of G-6-PD deficiency and by 15% in a more culturally diverse city. The main reported motivation for use was the fresh scent, not as a moth repellent. Conclusions: Mothballs are used for previously unrecognized reasons. Naphthalene-containing mothballs can pose a hematologic threat to vulnerable populations.