{'fraction_non_alphanumeric': 0.04326018808777429, 'fraction_numerical': 0.02445141065830721, 'mean_word_length': 4.741007194244604, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
HEMOLYSIS DURING SULFASALAZINE (S) THERAPY FOR PEDI-ATRIC INFLAMMATORY BOWEL DISEASE

Adverse hematologic reactions to S therapy have been well-documented in isolated IBD patients. In prior reports, hemolysis lias been noted to be infrequent, and has occurred within 2-4 weeks of initiation of therapy or coincident with an increase in dosage. Most have been receiving generally high dosages (>4g/day). These toxic manifestations are generally believed to be associated with a slow-acetylator phenotype. After diagnosing three individuals with S-induced hemolytic anemia occurring from 2 to 30 months after the initiation of therapy, we undertook to study the prevalence of S-induced hemolysis in a group of IBD patients (3-19 y.o.) without evidence of active GI blood loss. Out of 20 patients (15 U.C., 5 Crohn's), nine (45%) exhibited evidence of hemolysis by reticulocyte count (average 6.9%, range 2.4-12.8%) and haptoglobin level (average 10 mg/dl, range 0-30, nl 100-300 mg/dl). The average dosage was only 50 mg/kg/day S with a maximum of 3g/day. Upon cessation of S, hemolysis promptly resolved and the hemoglobin level increased an average of 2.1g/d. Prior observation of this hemolysis was obscured by the common occurrence of anemia and reticulocytosis in IBD, and by the laboratory variability in measurement of reticulocyte count.We conclude that in pediatric IBD patients S-induced hemolysis is common, often late in onset, and occurs with modest dosages. Patients on S-therapy should be followed with routine reticulocyte counts and haptoglobin levels as long as therapy persists.