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drug-induced hemolytic anemia
(may be IgG or IgM) [refs. 1 & 2]
Etiology:
- aminosalicyclic acid
- cephalosporins (especially 3rd generation)
- chlorpromazine
- dapsone
- insulin
- isoniazid
- levodopa
- mefenamic acid
- melphalan
- methyldopa
- penicillins
- phenacetin
- procainamide
- quinidine
- rifampin
- sulfonamides
Epidemiology: 10% of patients with autoimmune hemolytic anemia
Laboratory:
1) laboratory evidence of hemolytic anemia
a) elevated unconjugated (indirect) bilirubin
b) elevated serum lactate dehydrogenase (LDH)
c) positive direct antiglobulin test (DAT)
2) route tests for erythrocyte antibodies are negative
3) an eluate from the patient's erythrocytes are NOT reactive with normal erythrocytes
4) indirect antiglobulin test (Coomb's) is positive when erythrocytes coated with the drug are incubated with the patient's serum
5) reticulocyte count generally elevated*
6) MCV generally elevated*
* no additional conditions present impairing erythropoiesis [3]
General
hemolytic anemia
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 579-80
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 829-39
- Medical Knowledge Self Assessment Program (MKSAP) 11, 18, 19.
American College of Physicians, Philadelphia 1998, 2018, 2022.
- Mayer B, Bartolmas T, Yurek S, Salama A.
Variability of Findings in Drug-Induced Immune Haemolytic
Anaemia: Experience over 20 Years in a Single Centre.
Transfus Med Hemother. 2015 Sep;42(5):333-9.
PMID: 26696803 Free PMC Article