Increased in vitro erythrocyte sensitivity to the hemolytic effects of hydrogen peroxide (H2O2) in the H2O2 fragility test has been widely associated with vitamin E deficiency. In the present study, H2O2 red cell fragility was abnormally elevated in many types of acquired and congenital anemias in children who were tocopherol sufficient. In addition to abnormal red cell H2O2 sensitivity known to occur in vitro in conditions involving defects in cellular devices for disposal of peroxides, it is likely that a wide variety of erythrocyte dysfunctions result in increased in vitro H2O2 hemolysis even in situations where the usually adequate mechanisms for peroxide detoxification are present.

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