Bosentan-induced immune hemolytic anemia in 17 years old man. A case report

Abstract

Hemolytic anemia is a very important immune-mediated reaction, which its late diagnosis can be fatal. Medications along with other causes can induce hemolytic anemia. Drug induced immune hemolytic anemia (DIIHA) is caused by the development of autoantibodies. Accordingly, DIIHA is rare and there is not enough data for its prevalence. Number of drugs that can cause DIIHA have increased in recent decades. A 17-year-old man who had congenital single ventricle heart (CHB) and pulmonary artery hypertension (PAH) was admitted at Imam Khomeini hospital complex affiliated to Tehran University of Medical Sciences, with chief complaint of jaundice and icter. Bosentan and Tadalafil were in the list of the drugs used by this patient. Although both drugs were recommended to be discontinued in the patient, in the course of hospitalization, the patient accidentally continued to take his Tadalafil. However, the patient's recovery continued. Given that the patient's Coombs test was positive, his hemolytic anemia mechanism was drug-induced immune-mediated hemolytic anemia. As a result, according to Naranjo score = 6, Bosentan was considered as the main possible culprit to induce DIIHA in this patient. Following the discontinuation of Bosentan and receiving Prednisolone, the patient's clinical symptoms and laboratory parameters resolved and the patient was then discharged. Keywords Drug-induced immune hemolytic anemia (DIIHA) . Pulmonary artery hypertension (PAH) . Bosentan . Hemolytic anemia . Congenital heart block (CHB) Abbreviations ALP Alkaline phosphatase ALT Alanine aminotransferase AST Aspartate aminotransferase BIL Bilirubin BP Blood pressure * Soha Namazi

A case of hypertensive nephropathy who died of piperacillin- tazobactam induced immune hemolytic anemia which aggravated renal dysfunction: complete follow-up of serology and disease course

“…In China, DIIHA has not yet been included in the medication risk monitoring system. It is now clear that there are nearly 140 drugs that can cause DIIHA through immune complex mechanisms (ie, drug-induced antibodies) [5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]38] , but DIIHA has not been included in the list of side effects of these drugs, and there is a lack of DIIHA vigilance, the vast majority of DIIHA may be missed, misdiagnosed, delayed in diagnosis, or given improper intervention, which increases the risk of patients' administration. Incorporating DIIHA into the medication risk monitoring system and improving the awareness and vigilance of DIIHA will help avoid the serious consequences of DIIHA on patients.…”

“…The NIPA mechanism can only cause a positive result of the direct antiglobulin test (DAT) and slow, di cult to observe slight hemolysis [6][7][8] . It has been reported that nearly 140 kinds of drugs can cause DIIHA through drug-induced antibodies, and there are 10 kinds of drugs with NIPA effect [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

“…The NIPA mechanism can only cause a positive result of the direct antiglobulin test (DAT) and slow, di cult to observe slight hemolysis [6][7][8] . It has been reported that nearly 140 kinds of drugs can cause DIIHA through drug-induced antibodies, and there are 10 kinds of drugs with NIPA effect [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .Piperacillin is a semi-synthetic penicillin against pseudomonas, which belongs to the β-lactam broad-spectrum antibiotics and exerts bactericidal activity by inhibiting the synthesis of sensitive bacterial cell walls. Because some pathogenic bacteria can produce β-lactamase and are resistant to β-lactam antibiotics.…”

Case Report: Oral Cimetidine Administration Causes Drug-Induced Immune Hemolytic Anemia by Eliciting the Production of Cimetidine-Dependent Antibodies and Drug-Independent Non-specific Antibodies

“…More than 140 drugs are associated with drug-induced immune hemolytic anemia (DIIHA) (1)(2)(3)(4)(5)(6)(7)(8)(9). The pathogenic mechanism of DIIHA involves the damage of red blood cells (RBCs) by drug-induced (drug-dependent and -independent) antibodies or non-immune protein adsorption (NIPA) (10)(11)(12)(13).…”

Case Report: First Case of Cefotaxime-Sulbactam-Induced Acute Intravascular Hemolysis in a Newborn With ABO Blood Type Incompatibility by the Mechanism of Non-Immunologic Protein Adsorption

“…Drug-induced immune hemolytic anemia (DIIHA) is a rare disease resulting from immune damage to red blood cells (RBCs) caused by drug-induced antibodies or non-immunologic protein adsorption (NIPA) (1)(2)(3)(4), and nearly 140 drugs have been reported to cause DIIHA via drug-induced antibodies, and approximately 10 via NIPA (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Cefotaxime (CTX) is a thirdgeneration cephalosporin, which is a b-lactam broad-spectrum antibiotic.…”