Autoimmune Haemolytic Anaemia and Mefenamic Acid Therapy

Scott, G. L.; Myles, A. B.; Bacon, P. A.

doi:10.1136/bmj.3.5617.534

Cited by 52 publications

(9 citation statements)

References 8 publications

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“…Nevertheless, some interesting associations were found. Four patients had undergone radioactive thyroid ablation and one a partial thyroidectomy, but all seemed to be euthyroid and receivingadequate thyroxine replacement (Horton et al, 1976); five had rheumatoid arthritis, and although three were being treated with mefenamic acid none showed evidence of the haemolysis that may be caused by this drug (Scott et al, 1968); two had systemic lupus erythematosus; and five had hyperlipaemia.…”

Section: Unexplained Rises In MCVmentioning

confidence: 99%

High mean red cell volume: its incidence and significance in routine haematology.

Davidson¹,

Hamilton²

1978

J Clin Pathol

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SUMMARY With the advent of electronic particle counters of the Coulter S type the mean cell volume (MCV) has become an integral and useful feature of the red cell profile. Abnormally high values, often of minor degree, are particularly common but their precise clinical significance may be difficult to establish. This study defines the normal range and determines the incidence and distribution of the high MCV in routine hospital practice. Two hundred consecutive adult patients with an MCV of 100 fl or more were identified from the Coulter S analysis of 6542 blood samples and the underlying cause was established in 800%. Some of the clinical and economic implications of these findings are presented and briefly discussed.Red cell size has for many years been used to classify anaemia (Wintrobe, 1930). Early studies employed diffraction (Pijper, 1919) or the painstaking measurement of projected images (PriceJones, 1933) to detect changes in cell diameter in addition to the microscopic inspection of fixed and stained blood films with or without the aid of an eyepiece micrometer (Thorell, 1964). More recently cell size was related to mean cell volume (MCV), an index derived from the red cell count and packed cell volume. The adoption of this measurement, however, was restricted by the inaccuracies associated with visual red cell counting (Biggs and Macmillan, 1948) and the centrifuged haematocrit (England et al., 1972).A radical change followed the advent of electronic particle counters employing gating techniques (Mattern et al., 1957) that facilitated the rapid measurement of red cell volumes and their subsequent computation as MCV. While the electronically derived MCV has been generally regarded as more accurate than that of earlier methods it harbours several sources of error (England and Down, 1976) and, in our view, has also created new clinical, laboratory, and economic problems.The high capital cost, automation, and large work capacity of such instruments have all contributed towards the centralisation of routine "Present address:

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Section: Unexplained Rises In MCVmentioning

confidence: 99%

High mean red cell volume: its incidence and significance in routine haematology.

Davidson¹,

Hamilton²

1978

J Clin Pathol

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“…Based on experience with methyldopa, Worlledge (1973) states that to incriminate a drug in drug-induced AIHA a large proportion of patients who regularly take the drug should develop a positive OAT. This has not been the case with mefenamic acid, where Scott et al ( 1968) tested 36 patients taking mefenamic acid continuously for at least 3 months (range 3 to 31 months) and only one had a positive OAT that was subsequently negative. Yet mefenamic acid is the most frequently reported NSAID associated with AIHA.…”

Section: Review Of Nsalds Associated With Albamentioning

confidence: 72%

“…An example of conclusive evidence would be the 57-year-old female presented by Scott et al (1968), with positive DAT, anti-IgG, anti-c', IAT, IA T with eluates and enzyme-treated red cells, and autoantibodies with anti-e specificity (the e antigen is a component of the Rh group; antibodies to this represent Rh specificity) and a weak nonspecific component. Then, in decreasing order of certainty, the cases are rated as probable, likely, possible and no evidence.…”

Section: Review Of Nsalds Associated With Albamentioning

confidence: 97%

Fatal Fulminant Autoimmune Haemolytic Anaemia Associated with Tolmetin Use and Gastric Carcinoma

Larsen

Becher

1993

Drug Safety

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Presented is a case report of an 80-year-old man with dyspnoea and jaundice who died from autoimmune haemolytic anaemia (AIHA) within 12 hours of arrival at the emergency department. The patient had been taking tolmetin for osteoarthritis. On autopsy he was found to have a superficial gastric adenocarcinoma. A brief presentation on AIHA includes primary (idiopathic) and secondary types. Factors associated with AIHA include nonsteroidal anti-inflammatory drugs (NSAIDs) and gastric carcinoma, although a direct cause cannot be demonstrated. After a discussion of the autoimmune mechanism of drug-associated hemolysis of which methyldopa is the prototype, a review of NSAIDs associated with AIHA is presented. All (18) NSAID cases of immune haemolysis were reviewed to determine which were more likely due to an autoimmune mechanism. These included 3 cases with tolmetin use: one probable and one possibly having an autoimmune basis for haemolysis, while with the third case immune haemolysis was by the drug adsorption mechanism. A review of gastric carcinoma associated with AIHA reveals only 2 previously reported cases. The associations of tolmetin use, as well as gastric carcinoma with AIHA, both rare, are noteworthy but cannot be proven as causative factors with our current level of knowledge and technology.

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“…Scott et al (1968) reported 3 cases which developed after prolonged treatment (12 to 24 months). The direct antihuman gamma globulin test was positive in all cases.…”

Section: Thrombocytopeniamentioning

confidence: 99%

Aspirin, Paracetamol and Non-Steroidal Anti-Inflammatory Drugs

Fowler¹

1987

Medical Toxicology

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Non-steroidal anti-inflammatory drugs (NSAIDs) effectively control the symptoms of many of the rheumatic diseases although they have little effect on the underlying causes. Their effect is mainly on the mediators of the inflammatory process. Unfortunately, these mediators have important physiological roles in the maintenance of health, particularly in the gastrointestinal tract and the kidney, so that their inhibition results in many unwanted reactions of varying severity. The mechanisms underlying these reactions are described. Their occurrence varies, both qualitatively and quantitatively, and an attempt is made to assess these differences, although it may be that they are related directly to differences in dosage and therapeutic efficacy. In addition, immunologically mediated adverse reactions occur. These mechanisms are outlined and related to the clinical picture. There are considerable differences in frequency of reactions between the compounds: in particular there is a wide variation in the rate of dermatological reactions of this type. Agranulocytosis has been particularly associated with the pyrazolone compounds, although it has been reported with most others. Aplastic anaemia, which may not be an immune-mediated reaction, is also thought of as a pyrazolone reaction, but the incidence with indomethacin approaches a similar level. Although all drugs analysed may cause hepatic reactions, these are rare except with the now withdrawn benoxaprofen. Several types of immunologically mediated renal reactions occur and these rarities are also described. Paracetamol does not have any effect on the inflammatory mediators. Anxieties about this substance relates to the parent compound phenacetin and its necrotic effect on the renal papillae. There is extensive literature on this subject concerning not only paracetamol, but also aspirin and other NSAIDs. This is also assessed and summarised. The danger of paracetamol as a direct hepatic toxin in self-poisoning is discussed. Novel NSAIDs are introduced and others withdrawn with frequent and monotonous regularity. Sometimes the reasons have some medical or scientific plausibility, but often they are over-reactions by registration authorities or pharmaceutical companies in response to uninformed media publicity. The problems of the numerically and scientifically accurate collection and assessment of adverse reaction data are legion and as a result useful agents have been lost. Some of these difficulties are described, and some non-drug 'adverse reactions' are described.(ABSTRACT TRUNCATED AT 400 WORDS)

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Autoimmune Haemolytic Anaemia and Mefenamic Acid Therapy

Cited by 52 publications

References 8 publications

High mean red cell volume: its incidence and significance in routine haematology.

High mean red cell volume: its incidence and significance in routine haematology.

Fatal Fulminant Autoimmune Haemolytic Anaemia Associated with Tolmetin Use and Gastric Carcinoma

Aspirin, Paracetamol and Non-Steroidal Anti-Inflammatory Drugs

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