It should be part of the differential diagnosis for any normocytic or. The clinical importance of druginduced immune he molytic anemia is emphasized by the fact that acquired immune hemolytic anemia among 16 per cent of our. The estimated prevalence is approximately 1 in 1 million of the population. In some cases, a drug can cause the immune system to mistakenly think the bodys own red blood cells are dangerous, foreign substances. 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. Drugs are not the most common cause of hemolytic anemia. The most common drugs associated with diiha and the hypotheses for the mechanisms thought to.
Druginduced immune hemolytic anemia drugindependent antibodies drug does not need to be present to detect antibody appears as an autoantibody aiha methyldopa, fludarabine, procainamide drugdependent antibodies most drug antibodies drug has to be present to detect antibody in vitro. Druginduced immune hemolytic anemia hematology american. Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. However, when a patient develops hemolysis that may be drug induced, there are several challenges in evaluation and management including determining whether a drug is responsible, which drug is the likely culprit, and whether additional. Drug administration causes from 16 to 18 per cent of cases of acquired immune hemolytic anemia. Aplastic anemia was 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 the prescription medications that the patient is taking, but also overthecounter medications and even possible chemical exposures. Journal of blood group serology and molecular genetics. Removal of the offending drug is the primary treatment for drug induced oxidative hemolytic anemia. Druginduced immune hemolytic anemia american journal of.
It goes away when the drug is discontinued or the infection is treated. The drugs most frequently associated with diiha at this time are cefotetan, ceftriaxone, and piperacillin. In cases of controlled aiha, consider hepatitis c eradication 2c. Early diagnosis and proper treatment of drug induced anemias are crucial because of the seriousness of these disorders. To date, about 100 drugs have been implicated in causing a positive direct antiglobulin test dat andor hemolytic anemia. Druginduced immune hemolytic anemia diiha is a rare condition that occurs primarily as a result of druginduced antibodies, either drugdependent or drugindependent. The estimated incidence of diiha is around 1 in 1 million per year. Three distinct types of mechanism that render red cells sensitive to drug induced hemolysis have been delineated. The most common drugs associated with diiha and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. Acquired hemolytic anemia an overview sciencedirect topics. Learn the myriad causes of hemolytic anemia, common symptoms, and treatments to address this condition.
A disorder resulting from an abnormality of the immune system that destroys red blood cells prematurely. There are good data for drug induced thrombocytopenia 1018 cases per million 1,2 and neutropenia 215 cases per million,3 but only guesses for diiha. During the physical exam, your doctor will be checking for pale or yellowed skin. Diagnosing the cause of anemia nonimmune intravascular hemolysis and congenital hemolytic anemia look at patients medical history druginduced immune hemolytic anemia clinical symptoms of immune hemolysis, may be acute. Pdf drug induced immune hemolytic anemia researchgate. Druginduced immune hemolytic anemia uf health, university. The antibodies attach to red blood cells and cause them to break down too early. Pdf we studied the presence of drugdependent antibodies ddabs in 53 patients with aids who developed immune hemolytic anemia. The pathogenesis of erythrocyte sensitization by drug related antibody with or without fixation of complement is variable, and there is a relationship between the responsible drug, the mechanism of red cell sensitization, clinical manifestations and laboratory methods of diagnosis. Diiha is attributed most commonly to drugdependent.
In a few instances antibodies have been implicated clearly in drug reactions affecting the blood, 1 but more often this approach has been unrewarding. Gg diiha is rare, but there are no good data on the exact incidence and prevalence. A few drugs notably alpha methyldopa cause the development of autoimmune hemolytic anemia. Druginduced immune hemolysis diiha is a potential complication from drug administration and can be a serious condition. Druginduced immune hemolytic anemia definition of drug. Druginduced immune hemolytic anemia diiha is rare complication of any drug therapy. It occurs when drugs actively provoke red blood cell destruction. Druginduced immune hemolytic anemia the american journal of. Consider steroids for severe persistent haemolysis 2c. Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120 908 us veterans with hepatitis c virus infection. Congenital hemolytic anemia look at patients medical history druginduced immune hemolytic anemia clinical symptoms of immune hemolysis, may be acute. Once recognized, treatment options differ based on the nature of the antibody.
Aplastic anemia is the leading cause of death followed by thrombocytopenia, agranulocytosis, and hemolytic anemia. Drug dependent antibodies can be detected by testing drugtreated red blood cells rbcs or untreated rbcs in. Recently, a new mechanism of drug sensitivity has become apparent. Others are caused by your immune system breaking down the red blood cells, like autoimmune hemolytic anemia or hemolytic disease of the newborn. Few epidemiologic studies have evaluated the actual incidence. In hepatitis c eradication treatment naive patients with aiha, first line treatment is prednisolone 2c. In druginduced hemolytic anemia, there are several different mechanisms that cause hemolysis. D druginduced immune hemolytic anemia, american journal of clinical pathology, volume 96, issue 2, 1 august 1991, pages 288289, s. Knowledge of clinical manifestations and laboratory aids to. Drugdependent antibodies can be detected by testing drugtreated red blood cells rbcs or untreated rbcs in the presence of. Look for a relationship between the administration of a drug and the presence of hemolysis autoimmune hemolytic anemia blood bank serology combined with other laboratory. Druginduced immune hemolytic anemia diiha is a rare occurrence 1 in 1 million and is characterized by a decrease in hemoglobin following drug treatment. Drug induced immune hemolytic anemia diiha is rare.
Druginduced immune hemolytic anemia diiha is an uncommon entity that is frequently mistaken for warm autoimmune hemolytic anemia waiha. Look for a relationship between the administration of a drug and the presence of hemolysis autoimmune hemolytic anemia. Ingestion of any of a large number of drugs is followed by immunization and the formation of a soluble drugantidrug complex that adsorbs. Oct 31, 2019 how long hemolytic anemia lasts depends on its cause. Providing diagnosis and guidance to the inpatient care team is paramount because failure to recognize diiha may result in death. Druginduced anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia. Early diagnosis and proper treatment of druginduced anemias are crucial because of the seriousness of these disorders. Variability of findings in druginduced immune haemolytic anaemia. Jan 29, 2020 others are caused by your immune system breaking down the red blood cells, like autoimmune hemolytic anemia or hemolytic disease of the newborn. When certain drugs that are not toxic to the majority of the population are given to a few sensitive persons, marked hemolytic anemia occurs.
Review article druginduced megaloblastic, aplastic, and. Drug induced autoimmune hemolytic anemia is a form of hemolytic anemia. A lack of certain enzymes, which serve to maintain glutathione in the reduced form or which synthesize glutathione, renders the cell. The pathogenesis of erythrocyte sensitization by drugrelated antibody with or without fixation of complement is variable, and there is a relationship between the responsible drug, the mechanism of red cell sensitization, clinical manifestations and laboratory methods of diagnosis. The impact on a persons quality of life and life span can vary greatly. Hemolytic anemia caused by an inherited illness is a lifelong condition. Sep 15, 2018 hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. Drug induced hemolysis has large clinical relevance.
Autoimmune hemolytic anemia autoimmune hemolytic anemia aiha is mediated by autoantibodies and further subdivided according to their maximal binding temperature. Drug dependent antibodies can be detected by testing drug treated red blood cells rbcs or untreated rbcs in the presence of a solution of drug. 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. This issue of immunohematology on drug induced immune cytopenias hemolytic anemia, thrombocytopenia, and neutropenia was organized and guest edited by the late dr. The first case of druginduced immune hemolytic anemia due to hydrocortisone. It manifests if the production of the erythrocytes in the bone marrow is slower than their degradation. Immune hemolytic anemia associated with drug therapy. Fragmentation hemolysis and hypersplenism and druginduced hemolytic anemia. Druginduced immune hemolytic anemia occurs rarely 1 in 1 million population. Drug induced immune hemolytic anemia diiha is an uncommon entity that is frequently mistaken for warm autoimmune hemolytic anemia waiha. In drug induced hemolytic anemia, there are several different mechanisms that cause hemolysis when you are exposed to the medication or toxin. To continue reading this article, you must log in with your personal, hospital, or group practice subscription. Druginduced immune hemolytic anemia case study antibody.
An acquired hemolytic anemia can develop in association with drugs. Druginduced immune hemolytic anemia information mount. Immune hemolytic anemia is classified as autoimmune, alloimmune, or drug induced, based on the antigen that stimulates antibody or complementmediated destruction of red blood cells. The incidence of druginduced immune thrombocytopenia and neutropenia is quite well documented 10 to 18 and 2 to 15 cases per million, respectively, 1, 3 but there are no good data for diiha. Antibodies then develop against the red blood cells. This causes red blood cells to break down earlier than normal, a process called hemolysis. General information two different mechanisms of drug induced hemolytic anemia. Diiha is attributed most commonly to drug dependent. Druginduced immunemediated hemolytic anemia youtube. Druginduced 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 direct antiglobulin.
Abstract drug administration causes from 16 to 18 per cent of cases of acquired immune hemolytic anemia. Pathology consultation on druginduced hemolytic anemia. Autoimmune hemolytic anemia aiha, druginduced hemolytic anemia, and rh disease see online here hemolytic anemia is characterized by intravascular and extravascular destruction of erythrocytes. 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. Biochemical investigations of druginduced hemolytic anemias have clarified the mechanism of sensitivity in this disorder. The following list of medications are in some way related to, or. Immune haemolytic anaemias due to antibodies to red blood cells rbcs have been described for over 100 years. Dec 18, 2019 drug induced immune hemolytic anemia diiha is rare complication of any drug therapy. Three distinct types of mechanism that render red cells sensitive to druginduced hemolysis have been delineated.
Hemolytic anemia caused by a medication or infection is usually temporary. Immune hemolytic anemia is classified as autoimmune, alloimmune, or druginduced, based on the antigen that stimulates antibody or complementmediated destruction of red blood cells. Autoimmune hemolytic anemia aiha is defined as the increased destruction of red blood cells rbcs in the presence of antirbc autoantibodies andor complement. 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. However, when a patient develops hemolysis that may be drug induced, there are several challenges in evaluation and management including determining whether a drug is responsible, which drug. Chiao ey, engels ea, kramer jr, pietz k, henderson l, giordano tp, et al. Pdf the first case of druginduced immune hemolytic. Aug 04, 2012 drug induced immune hemolytic anemia occurs rarely 1 in 1 million population. Drug induced anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia. 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. Because the laboratory tests for this condition are not generally available, the true prevalence may be higher.
333 1609 569 1441 1246 595 510 1615 1544 545 690 1173 642 1394 1107 1510 584 423 1603 17 1082 535 277 1149 749 333 797 444 371 220 1290 940 671 904 968 182 158 1219 1499 849 43 188 997 577 1164 72