One center's experience: the serology and drugs associated with drug‐induced immune hemolytic anemia—a new paradigm
- 2 March 2007
- journal article
- Published by Wiley in Transfusion
- Vol. 47 (4), 697-702
- https://doi.org/10.1111/j.1537-2995.2007.01173.x
Abstract
BACKGROUND: Drug-induced immune hemolytic anemia (DIIHA) is an uncommon finding characterized by a sudden decrease in hemoglobin after treatment with the putative drug. The full range of drugs causing DIIHA and the initial serologic presentation are not fully appreciated. This work identifies additional drugs associated with DIIHA and offers additional insights about diagnosis. STUDY DESIGN AND METHODS: A 20-year retrospective review of testing in one laboratory was performed. Patient sex, age, medication history, initial direct antiglobulin test (DAT) and indirect antiglobulin test, method of drug-dependent antibody (DDA) detection, and specificity were reviewed. RESULTS: Seventy-one patients with 73 DDAs to 23 different drugs were identified. The following DDA specificities were identified: cephalosporins (37), penicillin and/or penicillin derivatives (12), nonsteroidal anti-inflammatory drugs (NSAIDs) (11), quinine and/or quinidine (7), and others (6). Fifty-two percent (37) were due to cephalosporins with 27 cefotetan-dependent antibodies detected. Four NSAIDs required urinary metabolite for detection. DAT was strongly positive, at least 2+, in 75 percent (51/68) of patients with a positive DAT. Initial eluate was negative in 52 patients, weak positive (<2+) in 14 patients, and strong positive (≥2+) in 2 patients. Serologic results showed characteristics of warm autoimmune hemolytic anemia (AIHA) in 22 or 31 percent of all cases and cold-reactive AIHA in 2 cases. CONCLUSIONS: It is important to consider DIIHA when a patient serologically presents as either warm- or cold-type AIHA to avoid erroneous diagnosis. Based on these findings, the strength of the initial DAT is much stronger than previously reported for all types of drug-induced immune hemolysis. This report is also unique in the number of NSAIDs reported. A new classification of categorizing DDA is proposed.This publication has 9 references indexed in Scilit:
- Misdiagnosis in patients with diclofenac-induced hemolysis: new cases and a concise reviewAmerican Journal of Hematology, 2006
- The Changing Spectrum of Drug-Induced Immune Hemolytic AnemiaSeminars in Hematology, 2005
- Two cases of immune haemolytic anaemia, associated with anti‐piperacillin, detected by the ‘immune complex’ methodVox Sanguinis, 2002
- Immune hemolytic anemia caused by sensitivity to a metabolite of etodolac, a nonsteroidal anti‐inflammatory drugTransfusion, 2000
- Serology of antibodies to second‐ and third‐generation cephalosporins associated with immune hemolytic anemia and/or positive direct antiglobulin testsTransfusion, 1999
- Sensitivity to a Metabolite of Diclofenac as a Cause of Acute Immune Hemolytic AnemiaBlood, 1997
- Antibodies in sulfonamide-induced immune thrombocytopenia recognize calcium-dependent epitopes on the glycoprotein IIb/IIIa complexBlood, 1994
- The Role of Metabolite-Specific Antibodies in Nomifensine-Dependent Immune Hemolytic AnemiaThe New England Journal of Medicine, 1985
- Immune Thrombocytopenia Due to a Drug MetaboliteThe New England Journal of Medicine, 1972