Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect

Abstract

Recent studies have reported that direct antiglobulin test (DAT) results were negative in cases of alectinib-induced hemolytic anemia with abnormal red blood cell (RBC) morphology. We herein report the case of a 72-year-old female patient who was diagnosed with alectinib-induced hemolytic anemia who - in contrast to previous reports - showed a positive DAT result. After discontinuing famotidine and alectinib, the DAT results turned negative; however, when alectinib was resumed, hemolysis recurred. Although alectinib-induced hemolytic anemia has been previously thought to be associated with abnormal morphological changes of the RBCs, we suggest that alectinib-induced anemia may manifest as DAT-positive immune hemolytic anemia because of a complementary effect with other drugs.

Drug Interaction-induced Hemolytic Anemia: An Unresolved Diagnostic Process

“…In the article accompanying this editorial, Isomura et al present a case with stage IV ALK-positive non-small cell lung cancer treated with alectinib, a highly selective second-generation ALK-targeting tyrosine kinase inhibitor ( 4 ). The patient developed hemolytic anemia six weeks after alectinib initiation.…”