AUTOIMMUNE HÆMOLYTIC ANÆMIA ASSOCIATED WITH Α-Methyldopa THERAPY

Worlledge, Sheila M.; Carstairs, K. C.; Dacie, J. V.

doi:10.1016/s0140-6736(66)92423-8

Cited by 208 publications

(56 citation statements)

References 7 publications

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“…A similar haemolytic anaemia had been reported in patients taking a-methyl dopa (Worlledge, Carstairs, and Dacie, 1966 Tables I and II, it appeared that mefenamic acid might be a superior analgesic with fewer side-effects than indomethacin. We therefore decided to study mefenamic acid further and a double-blind controlled trial against a placebo was conducted.…”

Section: Investigationssupporting

confidence: 74%

Mefenamic acid in rheumatoid arthritis.

Myles¹,

Bacon²,

Williams³

1967

Annals of the Rheumatic Diseases

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Section: Investigationssupporting

confidence: 74%

Mefenamic acid in rheumatoid arthritis.

Myles¹,

Bacon²,

Williams³

1967

Annals of the Rheumatic Diseases

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“…In about 50% of cases of idiopathic warm antibody AIHA (32,33) and in all reported AIHA cases associated with a-methyldopa administration (34,35) (36). Patient F. G. was studied as a hematologically normal subject, but had a healing peptic ulcer; he had elevated levels of C' and C'3.…”

Section: Resultsmentioning

confidence: 99%

In vivo metabolism of complement

Petz¹,

Fink²,

Letsky³

et al. 1968

J. Clin. Invest.

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“…A feature common to both disorders is that the red cell-binding IgG shows an Rhrelated specificity. The a-MD IgG, in some patients, has a partial specificity for Rh antigens such as e and c; reacts poorly or not at all with Rh-null red cells, and binds to the red cells of lower primates that contain Rh antigens (3,7,8,(17)(18)(19)(20). The serological and hematological changes associated with the administration of a-MD represents a potentially useful model for (21).…”

Section: Discussionmentioning

confidence: 99%

“…In spite of the presence of a strongly positive direct antiglobulin reaction, less than 1% of the patients on a-MD therapy develop overt hemolysis (3,4). In contrast to other types of drug-induced immune hemolysis, in which the drug participates in the immune reaction such as with penicillin (5, 6), a-MID does not participate in the interaction of the a-MD-induced IgG with red cells.…”

Section: Introductionmentioning

confidence: 96%

Ultrastructural mapping of methyldopa and anti-D IgG erythrocyte antigen receptors.

Masouredis¹,

Sudora²

1975

J. Clin. Invest.

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A B S T R A C T The ultrastructural distribution pattern and site density of a-methyldopa immunoglobin G (a-AID IgG) on the red cell membrane was observed and compared with that of anti-D IgG, with ferritin-conjugated rabbit anti-human IgG and ['I] METHODSPatient source of a-MD red cell-binding IgG. IgG containing eluates were prepared from the red cells of six patients who ranged in age from 27 to 81 yr and who had been treated for hypertension with a-MD from 1 to 5 yr. Four of the six patients were blood donors found to have a positive direct antiglobulin reaction due to JgG when their blood was processed. They had met the criteria for blood donation, but had neglected to disclose that they had been on a-MD therapy for hypertension, which was subsequently ascertained by a followup investigation. Two of the six patients had been hospitalized for a Coombs-positive, IgGspecific, hemolytic anemia (Hb 8.2 and 7.4 g/100 ml), and reticulocytosis. A presumptive diagnosis of a-MD-induced hemolytic anemia was made since there was no other clinical explanation for the hemolysis and there was clinical and serological resolution of the anemia within 3-6 mo after cessation of the a-MD administration. The patient group consisted of four women and two men; five were blood group 0, Rh positive, and one was blood group A, Rh negative.Preparation of a-MD IgG eluates. The a-MD IgG containing eluates were obtained by acid elution of the patient's IgG-coated red cells by the method employed for the preparation of ['JI]anti-D IgG (9, 11). The eluates were concentrated about 10-fold by pressure dialysis and then equilibrated by dialysis against buffered normal saline (BNS), pH 6.5, containing 0.25%o phenol and 1: 10,000 merthiolate. The concentrated eluates were hemoglobin tinged and from 1 to 8 ml of packed red cells was used to prepare 1 ml of eluate. In some patients the red cell-binding a-MD IgG free in the plasma was isolated by sensitizing at 370C for 1 h normal, washed, 0, Rh-positive red cells with the patient's plasma. The plasma a-MD IgG was then recovered by acid elution of the sensitized red cells as described above.Characterization of the a-MD IgG eluates. The a-MDcontaining eluates sensitized both Rh-positive and negative red cells to give 4 plus antiglobulin reactions. The antiglobulin titers ranged from 32 to 256 with an RR1 cell and a commercial multivalent antiglobulin reagent. Eluates derived from the plasma a-MD IgG gave weaker reactions, from 2 to 3 plus. There were weak (±+ to +) reactions, except for a 3 plus reaction with one eluate (Ber.) with both type A2 and 0 frozen and fresh Rh-null red cells. The reaction with Rh-null cells in all cases was significantly less than that observed with random Rh-positive and negative human red cells. One eluate (Hil.) sensitized an LWnegative human red cell to give a 4+ antiglobulin reaction. The eluates reacted with both gorilla and chimpanzee erythrocytes to give 2-4 plus antiglobulin reactions. Immunoelectrophoresis of the highly concentrated eluates (50-100-fold) conta...

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AUTOIMMUNE HÆMOLYTIC ANÆMIA ASSOCIATED WITH Α-Methyldopa THERAPY

Cited by 208 publications

References 7 publications

Mefenamic acid in rheumatoid arthritis.

Mefenamic acid in rheumatoid arthritis.

In vivo metabolism of complement

Ultrastructural mapping of methyldopa and anti-D IgG erythrocyte antigen receptors.

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