Drug-Induced Immune Hemolytic Anemia

Petz, Lawrence D.

doi:10.1016/b978-0-443-08559-8.50012-1

Cited by 80 publications

(96 citation statements)

References 275 publications

(225 reference statements)

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“…The patient's serum was tested with the meropenemtreated and untreated RBCs according to a previously described test tube method (7). Briefly, two drops of serum were incubated with one drop of meropenem-treated or control untreated RBCs.…”

Section: Meropenem-coating Methodsmentioning

confidence: 99%

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

2015

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A 76-year-old woman treated with meropenem developed intravascular hemolytic attacks. A direct antiglobulin test was positive for C3d and IgG, and drug-dependent antibody testing indicated that the antibodies were indeed drug-dependent and reacted with drug-treated RBCs and RBCs in the presence of the drug. To our knowledge, this is the first reported case in which the causative antibodies related to meropenem were identified. This case highlights the importance of maintaining a high level of suspicion for drug-induced immune hemolytic anemia in patients with explained hemolysis as well as conducting specialized serologic testing.

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Section: Meropenem-coating Methodsmentioning

confidence: 99%

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

2015

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“…It is still unknown why or how some drugs can affect the immune system to cause RBC autoantibody formation, with or without HA. 4,8 The prototype drug is methyldopa, which causes the production of RBC autoantibodies in about 15% of the patients receiving the drug, but only about 0.5% to 1% develop an HA. Fludarabine is now the most common drug to induce RBC autoantibodies.…”

Section: Suggested Mechanisms Involved In Diihamentioning

confidence: 99%

“…We have roughly estimated it to be around 1 in 1 million of the population, by comparing it to autoimmune hemolytic anemia (AIHA), which has been reported to occur in 1 in 80,000 of the population. 4 Over a 40-year experience we have encountered AIHA about ten times more often than DIIHA. 4 I believe this is a low estimate for DIIHA as only the more dramatic hemolysis leads to the appropriate investigations to prove that a drug is causing an immune hemolytic anemia (HA).…”

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confidence: 99%

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Drug-induced immune hemolytic anemia

Garratty¹

2009

Hematology

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205

229

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Drug-induced immune hemolytic anemia (DIIHA) is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. The most common drugs associated with DIIHA and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. The drugs most frequently associated with DIIHA at this time are cefotetan, ceftriaxone, and piperacillin. DIIHA is attributed most commonly to drug-dependent antibodies that can only be detected in the presence of drug (eg, cephalosporin antibodies). DIIHA can also be associated with drug-independent antibodies; such antibodies do not need drug to be present to obtain in vitro reactions (eg, fludarabine). In these latter cases, the drug affects the immune system, causing production of red cell (RBC) autoantibodies; the clinical and laboratory findings are identical to autoimmune hemolytic anemia (AIHA), other than the remission associated with discontinuing the drug. Some of the mechanisms involved in DIIHA are controversial. The most acceptable one involves drugs, like penicillin, that covalently bind to proteins (eg, RBC membrane proteins); RBCs become coated with drug in vivo and, a drug antibody (usually IgG) attaches to the drug-coated RBCs that are subsequently cleared by macrophages. The most controversial is the so-called immune complex mechanism, which has been revised to suggest that most drugs are capable of binding to RBC membrane proteins, but not covalently like penicillins. The combined membrane plus drug can create an immunogen; the antibodies formed can be IgM or IgG and often activate complement, leading to acute intravascular lysis and sometimes renal failure; fatalities are more common in this group. It is still unknown why and how some drugs induce RBC autoantibodies, sometimes causing AIHA.

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“…9 Our patient had mild haemolysis evident on 2 nd postoperative day reflected by a drop in haemoglobin level to 7.7 gm% and an increase in RC from 1% to 2.5%. It was corrected by transfusing one unit packed cells.…”

Section: Jsan 2016; 3 (2)mentioning

confidence: 99%

Anaesthetic management of a patient with glucose-6-phosphate dehydrogenase deﬁciency undergoing robotic-assisted laparoscopic radical prostatectomy

Bhageria

Chowdhury

Goel

et al. 2016

J. Soc. Anesth. Nep.

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Glucose-6-phosphate dehydrogenase deﬁcient patients may develop acute haemolysis after exposure to the oxidative stress of surgery, and certain anaesthetic or analgesic agents. The steep Trendelenburg position, pneumoperitoneum, and associated extreme hemodynamic changes in robotic surgery add on to oxidative stress. Here, we present a 68-year-old Glucose-6-phosphate dehydrogenase deﬁcient patient who uneventfully underwent robotic-assisted laparoscopic radical prostatectomy focussing on avoidance of drugs predisposing haemolysis, minimising surgical stress, providing adequate anxiolysis, analgesia, stable haemodynamics and depth of anaesthesia that is unique to robotic surgery.

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Drug-Induced Immune Hemolytic Anemia

Cited by 80 publications

References 275 publications

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

Drug-induced immune hemolytic anemia

Anaesthetic management of a patient with glucose-6-phosphate dehydrogenase deﬁciency undergoing robotic-assisted laparoscopic radical prostatectomy

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