Drug induced hemolytic anemia is a very rare but potentially lethal adverse drug reaction, which can take the form of oxidative damage to vulnerable erythrocytes as in glucose6phosphate dehydrogenase deficiency, drug induced thrombotic microangiopathy, or immunemediated hemolytic anemia. Biochemical investigations of drug induced hemolytic anemias have clarified the mechanism of sensitivity in this disorder. Drug induced hemolytic anemia, medication causes of hemolytic anemia, drug induced immunemediated hemolysis, drug induced immune hemolytic anemia, drug induced autoimmune hemolytic anemia, drug induced thrombotic microangiopathic anemia. Certain drugs can induce immune responses, with the resulting antibodies targeting against the rbcs, causing drug induced hemolytic anemia diiha. Review article druginduced megaloblastic, aplastic, and. Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120 908 us veterans with hepatitis c virus infection. Removal of the offending drug is the primary treatment for drug induced oxidative hemolytic anemia.
Coombspositive druginduced hemolytic anemia american. Hemolytic anemia caused by an inherited illness is a lifelong condition. This page includes the following topics and synonyms. Drug induced hemolytic anemias and congenital galactosemia paul a. Sep 15, 2018 drug induced immune hemolytic anemia beta lactamase inhibitors, cefotetan cefotan, ceftriaxone, fludarabine, intravenous immunoglobulin, methlydopa, nonsteroidal antiinflammatory drugs.
Two cases of coombspositive druginduced hemolytic anemia are presented. Arndt druginduced immune hemolytic anemia diiha is a rare condition that occurs primarily as a result of druginduced. Dec 18, 2019 drug induced immune hemolytic anemia diiha is rare complication of any drug therapy. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Aplastic anemia is the leading cause of death followed by thrombocytopenia, agranulocytosis, and hemolytic anemia. In investigating the possibility of a druginduced hemolytic anemia, one must consider not only. Aplastic anemia was the leading cause of death followed by thrombocytopenia, agranulocytosis, and hemolytic anemia.
Drug induced anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia introduction drug induced anemia and other blood disorders are potentially dangerous and have long. Generally, druginduced hemolytic anemia is based on 3 different mechanisms, which is why different reactions between antibodies and complements occur. Ingestion of any of a large number of drugs is followed by immunization and the formation of a soluble drugantidrug complex that adsorbs. Certain drugs can induce immune responses, with the resulting antibodies targeting against the rbcs, causing druginduced hemolytic anemia diiha.
Druginduced immune hemolytic anemia diiha is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. These drugs bind to the surface of red blood cells and stimulate the immune system to produce antibodies directed at the drug itself or at an epitope created by the combination of drug and rbc membrane. Diagnosis of druginduced hemolytic anemia starts like most forms of anemia, with the complete blood count cbc. Gross presented as part of a program on inborn errors of metabolism, at the meeting of the section on pediatrics of the new york academy of medicine, december 11, 1958. Immune hemolytic anemia immune hemolytic anemias are mediated by antibodies directed against antigens on the red blood cell surface. How long hemolytic anemia lasts depends on its cause. In 1980, we reported that in 347 cases of immune hemolytic anemia, approximately 12% were druginduced.
Anemia is indicated by low hemoglobin andor hematocrit. Immune hemolytic anemia is classified as autoimmune, alloimmune, or drug induced, based on the. Autoimmune hemolytic anemia aiha, druginduced hemolytic anemia, and rh disease see online here hemolytic anemia is characterized by intravascular and extravascular. Autoimmune hemolytic anemia aiha, druginduced hemolytic anemia, and rh disease see online here hemolytic anemia is characterized by intravascular and extravascular destruction of erythrocytes. Recently, a new mechanism of drug sensitivity has become apparent. Over individual drugs have been implicated but the most commonly reported include second. Microspherocytes on a peripheral smear and a positive direct.
Microspherocytes on a peripheral smear and a positive direct antiglobulin test are the characteristic findings. This causes red blood cells to break down earlier than normal, a process called hemolysis. Druginduced immune hemolytic anemia diiha is a rare occurrence 1 in 1 million and is characterized by a decrease in hemoglobin following drug treatment. Antibodies do not activate complement and persist after the termination of medication e. Jan 01, 2009 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.
Druginduced immune hemolytic anemia diiha is an uncommon entity that is frequently mistaken for warm autoimmune hemolytic anemia waiha. Druginduced hemolytic anemia definition of druginduced. Aiha, drug induced immune hemolytic anemia may cause spherocytes. The three main types of immune hemolytic anemia are autoimmune, alloimmune, and druginduced. In hemolytic anemia, red blood cell production is accelerated resulting in an increased number of reticulocytes, immature red blood cells.
Pathology consultation on druginduced hemolytic anemia. Intrinsic hemolytic anemia develops when the red blood cells produced by your body dont function properly. These drugs bind to the surface of red blood cells. Nonimmune hemolytic anemia, in contrast, comprises three main categories, consisting of microangiopathic anemias usually induced by some chemotherapeutic agents. In investigating the possibility of a drug induced hemolytic anemia, one must consider not only the prescription medications that the patient is taking, but also overthecounter medications and even possible chemical exposures. Few epidemiologic studies have evaluated the actual incidence. Rituximab is becoming the preferred secondline choice for steroidrefractory warm autoimmune hemolytic anemia waiha and the firstline choice for cold agglutinin disease cad. In immune hemolytic anemia, your immune system destroys your red blood cells. Numerous chemical compounds, usually drugs, have been observed to cause hemolytic anemias.
A lack of certain enzymes, which serve to maintain glutathione in the reduced form or which synthesize glutathione, renders the cell. Drug induced immune hemolytic anemia beta lactamase inhibitors, cefotetan cefotan, ceftriaxone, fludarabine, intravenous immunoglobulin, methlydopa, nonsteroidal antiinflammatory drugs. Jan 29, 2020 diagnosis of drug induced hemolytic anemia starts like most forms of anemia, with the complete blood count cbc. Chiao ey, engels ea, kramer jr, pietz k, henderson l. 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. One case was associated with the prolonged administration of methyldopa aldomet. Anemia also spelled anaemia is a decrease in the total amount of red blood cells rbcs or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. It goes away when the drug is discontinued or the infection is treated. The estimated incidence of diiha is around 1 in 1 million per year. Druginduced immune hemolytic anemia diiha is rare complication of any drug therapy. Druginduced hemolytic anemias and congenital galactosemia. Providing diagnosis and guidance to the inpatient care team is paramount because failure to recognize diiha may result in death. Druginduced hemolytic anemia, medication causes of hemolytic anemia, drug induced immunemediated hemolysis, druginduced immune.
Druginduced hemolytic anemias and congenital galactosemia paul a. Arndt drug induced immune hemolytic anemia diiha is a rare condition that occurs primarily as a result of drug induced antibodies, either drug dependent or drug independent. Immune hemolytic anemia associated with drug therapy. Drugs are not the most common cause of hemolytic anemia. Hemolytic anemia caused by a medication or infection is usually temporary. Druginduced immune hemolytic anemia case study antibody. Drug dependent antibodies can be detected by testing drug treated. Drug induced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the bodys defense immune system to attack its own red blood cells. Drug induced autoimmune hemolytic anemia is a form of hemolytic anemia. General information two different mechanisms of drug induced hemolytic anemia. Antibodies then develop against the red blood cells.
In a few instances antibodies have been implicated clearly in drug reactions affecting the blood, 1 but more often this approach has been unrewarding. Primaquine, developed during the close of world war ii, is the most effective curative antimalarial agent presently available. It manifests if the production of the erythrocytes in the bone marrow is slower than their degradation. Chiao ey, engels ea, kramer jr, pietz k, henderson l, giordano tp, et al. Acquired hemolytic anemia an overview sciencedirect topics. Hemolytic anemia may result from the administration of oxidant drugs, including primaquine, sulfonamides, nitrofurantoin, acetylsalicylic acid, and acetophenetidine 14. Druginduced hemolytic anemia is a very rare but potentially lethal adverse drug reaction, which can take the form of oxidative damage to vulnerable erythrocytes as in glucose6phosphate dehydrogenase. Drug induced immune hemolytic anemia diiha first suspected in 1953 by snapper et al ann int med, 619 first documented in 1956 by harris j lab clin med, 760 by 1967, 34 published cases involving 15 drugs. However, when a patient develops hemolysis that may be drug induced, there are several challenges in evaluation and. Drug induced immune hemolytic anemia diiha is rare. Once recognized, treatment options differ based on the nature of the antibody. However, in sensitive persons, it gives rise to an acute, selflimited hemolytic. Druginduced hemolytic anemia and thrombocytopenia associated. In some cases, a drug can cause the immune system to mistakenly think the bodys own red blood cells are dangerous, foreign.
The impact on a persons quality of life and life span can vary greatly. Generally, drug induced hemolytic anemia is based on 3 different mechanisms, which is why different reactions between antibodies and complements occur. However, rituximab is an expensive treatment that is not available worldwide. In 1980, we reported that in 347 cases of immune hemolytic anemia, approximately 12% were drug induced. Journal of blood group serology and molecular genetics. Megaloblastic, aplastic and hemolytic anemias are the most common drug induced anemias. Drug induced immune hemolytic anemia diiha is an uncommon entity that is frequently mistaken for warm autoimmune hemolytic anemia waiha. Final diagnosis druginduced immune hemolytic anemia. Hemolytic anemia drugs and hemolytic anemia cephalosporins and hemolytic anemia piperacillin and hemolytic anemia fludarabine and hemolytic anemia drug antibodies drug induced immune hemolytic anemia diiha is rare. Three distinct types of mechanism that render red cells sensitive to drug induced hemolysis have been delineated. Druginduced hemolytic anemia annals of internal medicine. Hemolytic anemia drugs and hemolytic anemia cephalosporins and hemolytic anemia piperacillin and hemolytic anemia fludarabine and hemolytic anemia drug antibodies druginduced immune hemolytic.
An acquired hemolytic anemia can develop in association with drugs. When certain drugs that are not toxic to the majority of the population are given to a few sensitive persons, marked hemolytic anemia occurs. Recent publications have emphasized the close etiological relationship of erythrocyte glucose6phosphate dehydrogenase g6pd deficiency to this type of drug induced. The mechanisms of drug induced anemia can be explained in terms of either direct immune reaction or drug or metabolite toxicity. It has been reported that 125 drugs are involved in diiha 5. Druginduced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the bodys defense immune system to attack its own red blood cells. Diiha is a rare but serious complication of drug treatment. Aiha, druginduced immune hemolytic anemia may cause spherocytes. Warm aiha and druginduced hemolytic anemia warm approach to the adult with anemia view in chinese inherited hemolytic anemias eg, hereditary spherocytosis, sickle cell disease, pyruvate. The most common drugs associated with diiha and the hypotheses for the mechanisms thought to be involved have changed during the last few decades.