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Cheng Q, Wu Y, Yao Z, Ouyang M, Zou S, Shi X, Zhao Y, Sun M. Coagulation dysfunction events associated with echinocandins: a real-world study from FDA adverse event reporting system (FAERS) database. Thromb J 2024; 22:78. [PMID: 39180077 PMCID: PMC11344304 DOI: 10.1186/s12959-024-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/23/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Echinocandins belong to the fourth generation of antifungals, and there are no systematic studies on their risk in coagulation dysfunction; this study will predict the risk of coagulation dysfunction of echinocandins using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. METHOD Data from January 2004 to March 2024 were obtained from FAERS. We examined the clinical characteristics of the coagulation dysfunction events and conducted disproportionality analysis by using reporting odds ratios (ROR) to compare echinocandins with the full database. RESULTS There were 313 reports of coagulation dysfunction related to echinocandins as the primary suspect (PS) drug. The median time to incident for coagulation dysfunction was 3 (interquartile range [IQR] 1-9) days. Compared to triazoles and polyenes, echinocandins have a stronger signal (ROR 3.18, 95%CI 2.81-3.51, p < 0.01) of coagulation dysfunction. Compared to caspofungin and micafungin, anidulafungin has a stronger signal (ROR 6.84, 95%CI 4.83-9.70, p < 0.01). The strongest signal corresponding to disseminated intravascular coagulation (DIC), platelet count decreased, thrombocytopenia, gastrointestinal haemorrhage, cerebral haemorrhage, pulmonary haemorrhage and thrombotic thrombocytopenic purpura (TTP) is micafungin (ROR 27.19, 95%CI 18.49-39.98), micafungin (ROR 3.50, 95%CI 2.36-5.19), anidulafungin (ROR 9.75, 95%CI 5.22-18.19), micafungin (ROR 3.17, 95%CI 2.02-4.97), micafungin (ROR 4.95, 95%CI 2.81-8.72), caspofungin (ROR 20.76, 95%CI 11.77-36.59), micafungin (ROR 20.43, 95%CI 8.49-49.14), respectively. CONCLUSIONS For coagulation dysfunction, we found stronger signals for echinocandins than triazoles and polyenes, and stronger signals for anidulafungin than micafungin and caspofungin. Coagulation parameters should be closely monitored while using the respective drugs.
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Affiliation(s)
- Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ye Wu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zeyu Yao
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Mengling Ouyang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shupeng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yazheng Zhao
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Minghui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Ilardo C, Coulon G, Lancien A, Olejnik Y, Barthes J. Adjustment of lactate dehydrogenase concentration results according to the haemolysis index following in vitro haemolysis. Scand J Clin Lab Invest 2024:1-6. [PMID: 39153181 DOI: 10.1080/00365513.2024.2392633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/18/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
In the presence of haemolysis, the interpretation of the Lactate dehydrogenase (LDH) activity result is a major operational challenge for medical laboratories: if the origin is intravascular, then the measurement will reflect the clinical reality, but in extravascular haemolysis, the laboratory will be confronted with an artefactual increase leading to false-positive high results. The aim of our study was to evaluate the adjustment of LDH concentration results according to the haemolysis index (HI). After designed a mathematical model to correct the LDH measured as a function of the haemolysis index using a Cobas 8000 analyser (Roche diagnostics, Mannheim, Germany), LDH measurement of seventy-four duplicate samples were tested before and after exposure to extravascular haemolysis process. After in vitro haemolysis process, a significant increase haemolysis index (Man-Whitney U-Test p < 0.0001) were observed. Before process the HI median was 4 [2.0 - 6.75] and after HI median was 18 [10 - 35.75]. Without correction, LDH results showed a significant increase (p < 0.001) after haemolysis process and substantial analytical discrepancies (31/74) were observed according to TEa of CLIA. After correction, data showed no significant difference (p = 0.497) and the mathematical algorithm allowed to reduce the analytical discrepancies (2/74). If haemolysis was present in vitro, the mathematical algorithm increased the accuracy of the LDH results. However, the lack of discrimination between in vivo and in vitro haemolysis requires caution and the results should be reported only as a commentary to inform the clinician.
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Affiliation(s)
| | | | | | - Yann Olejnik
- LABOSUD Laboratory (Inovie member), Montpellier, France
| | - Joel Barthes
- LABOSUD Laboratory (Inovie member), Montpellier, France
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3
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Green EA, Fogarty K, Ishmael FT. Penicillin Allergy: Mechanisms, Diagnosis, and Management. Med Clin North Am 2024; 108:671-685. [PMID: 38816110 DOI: 10.1016/j.mcna.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Allergy to penicillin can occur via any of the 4 types of Gel-Coombs hypersensitivity reactions, producing distinct clinical histories and physical examination findings. Treatments include penicillin discontinuation, and depending on the type of reaction, epinephrine, antihistamines, and/or glucocorticoids. Most beta-lactams may be safely used in penicillin-allergic patients, with the possible exception of first-generation and second-generation cephalosporins. Penicillin testing includes skin testing, patch testing, and graded challenge. The selection of the type of testing depends on the clinical setting, equipment availability, and type of hypersensitivity reaction. Desensitization may be used in some cases where treatment with penicillins is essential.
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Affiliation(s)
- Estelle A Green
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA
| | - Kelan Fogarty
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA
| | - Faoud T Ishmael
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA; Mount Nittany Health, 1850 East Park Avenue, State College, PA 16803, USA.
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4
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Bibb LA, Adkins BD, Stephens LD, Booth GS, Jacobs JW. Biologic immunomodulatory medications and autoimmune cytopenias: A cross-sectional analysis of a national surveillance database. J Am Acad Dermatol 2024; 91:153-156. [PMID: 38513833 DOI: 10.1016/j.jaad.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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5
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Lou C, Liu M, Ma T, Yang L, Long D, Li J, Lei H, Xiang D, Wang X, Li L, Cai X. Case report: Decreased hemoglobin and multiple organ failure caused by ceftizoxime-induced immune hemolytic anemia in a Chinese patient with malignant rectal cancer. Front Immunol 2024; 15:1390082. [PMID: 38756782 PMCID: PMC11096485 DOI: 10.3389/fimmu.2024.1390082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Drug-induced immune hemolytic anemia (DIIHA) is a rare but serious condition, with an estimated incidence of one in 100,000 cases, associated with various antibiotics. This study reports on a case of ceftizoxime-induced hemolysis observed in a patient in China. Case description A Chinese patient diagnosed with malignant rectal cancer underwent antimicrobial therapy after laparoscopic partial recto-sigmoid resection (L-Dixon). After receiving four doses of ceftizoxime, the patient developed symptoms including rash, itchy skin, and chest distress, followed by a rapid decline in hemoglobin levels, the presence of hemoglobin in the urine (hemoglobinuria), renal failure, and disseminated intravascular coagulation. Laboratory analysis revealed high-titer antibodies against ceftizoxime and red blood cells (RBCs) in the patient's serum, including immunoglobulin M (IgM) (1:128) antibodies and immunoglobulin G (IgG) (1:8) antibodies, with noted crossreactivity to ceftriaxone. Significant improvement in the patient's hemolytic symptoms was observed following immediate discontinuation of the drug, two plasma exchanges, and extensive RBC transfusion. Conclusion This case, together with previous reports, underscores the importance of considering DIIHA in patients who exhibit unexplained decreases in hemoglobin levels following antibiotic therapy. A thorough examination of the patient's medical history can provide crucial insights for diagnosing DIIHA. The effective management of DIIHA includes immediate cessation of the implicated drug, plasma exchange, and transfusion support based on the identification of specific drug-dependent antibodies through serological testing.
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MESH Headings
- Humans
- Rectal Neoplasms/drug therapy
- Rectal Neoplasms/immunology
- Rectal Neoplasms/surgery
- Hemoglobins/metabolism
- Anti-Bacterial Agents/adverse effects
- Male
- Ceftizoxime/adverse effects
- Multiple Organ Failure/etiology
- Middle Aged
- Anemia, Hemolytic/chemically induced
- Anemia, Hemolytic/immunology
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic, Autoimmune/chemically induced
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/diagnosis
- China
- East Asian People
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Affiliation(s)
- Can Lou
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Ma
- Blood Group Reference Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
- Department of Blood Transfusion, Shaanxi Provincial People’s Hospital, Xian, Shaanxi, China
| | - Liu Yang
- Blood Group Reference Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
- Department of Blood Transfusion, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan Long
- Department of Blood Transfusion, The Second Affiliated Hospital of Guizhou Medical University, Kaili, Guizhou, China
| | - Jiaming Li
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Lei
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Xiang
- Blood Group Reference Laboratory, Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohong Cai
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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6
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Dicaro MV, Chen C, Wang S, Eom AY, Wahi-Gururaj S. Ceftriaxone-Induced Hemolytic Anemia: A Rare and Fatal Reaction. Cureus 2024; 16:e59646. [PMID: 38832173 PMCID: PMC11146677 DOI: 10.7759/cureus.59646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
Ceftriaxone, a regularly used antibiotic for broad-spectrum coverage, is a rare cause of hemolytic anemia. Patients may present with truncal pain, nausea, vomiting, and an acute drop in hemoglobin within 48 hours of administration. Prompt recognition and initiation of treatment are essential. We describe a case of a 65-year-old woman being treated for osteomyelitis who developed hemolytic anemia, disseminated intravascular coagulation, and multi-system organ failure after being de-escalated from cefepime to ceftriaxone.
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Affiliation(s)
- Michael V Dicaro
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas (UNLV), Las Vegas, USA
| | - Claire Chen
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas (UNLV), Las Vegas, USA
| | - Shawn Wang
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas (UNLV), Las Vegas, USA
| | - Annette Y Eom
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas (UNLV), Las Vegas, USA
| | - Sandhya Wahi-Gururaj
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas (UNLV), Las Vegas, USA
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7
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Huang Q, Wu Y, Li H. Signal detection of adverse reactions for bendamustine based on FDA adverse event reporting system. Expert Opin Drug Saf 2024:1-11. [PMID: 38682580 DOI: 10.1080/14740338.2024.2348573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND This study aimed to analyze the adverse events to bendamustine using data obtained from the Food and Drug Administration open public data project (openFDA) and to provide a reference for its use in clinical practice. RESEARCH DESIGN AND METHODS Adverse events (AEs) due to bendamustine usage reported from 1 January 2008 to 31 March 2023 were collected from the FDA Adverse Event Reporting System (FAERS). The reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian plausible propagation neural network (BCPNN), and multinomial gamma-Poisson distribution shrinking (MGPS) algorithms were used to identify signs of adverse reactions caused by bendamustine. RESULTS A total of 4214 AE reports where bendamustine was considered as the first suspected drug were obtained from FAERS. The analysis revealed 214 AE risk signals, among which 141 met the criteria but they were not listed as possible side effects on the drug information sheet provided in the package. CONCLUSION Our findings identified numerous common AEs with previously reported clinical observations. We also identified some signs of potential new AEs, indicating the need of careful clinical monitoring of patients treated with bendamustine and further risk identification research about this drug.
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Affiliation(s)
- Qing Huang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, FengTai District, Beijing, China
| | - Yuanbin Wu
- Department of Emergency Medicine, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huimin Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, FengTai District, Beijing, China
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8
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Tang L, Ding C, Li H, Zhou X, Yin G. A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System. Ann Pharmacother 2024; 58:375-382. [PMID: 37522435 DOI: 10.1177/10600280231189897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening pharmacogenic hematological adverse effect. Updating the risk of DIIHA among the currently available drugs based on spontaneously reported adverse event data is of great significance. OBJECTIVE This study aimed to identify the top 50 drugs associated with immune hemolytic anemia in adults as well as common drugs that could cause immune hemolytic anemia in children based on the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. METHODS We extracted adverse events (AE) in the FAERS database from Q1 2004 to Q3 2022 using Open vigil2.1. We use the high-level term "anaemias haemolytic immune" according to the Medical Dictionary for Regulatory Activities (MedDRA) Dictionary (version 24.0). The reported correlation between drugs and DIIHA risk was identified by reported odds ratio (ROR) and proportional reporting ratio (PRR). RESULTS There were 10500309 AEs in FAERS from 2004Q1 to 2022Q3, of which 2326 (0.02%) were DIIHA cases. The incidence of DIIHA is comparable between males and females. The most common drugs associated with DIIHA in adults and children are summarized according to the number of AE reports. The top 3 categories in terms of quantity of drugs are antineoplastic agents, immunosuppressants, and antibiotics for systemic use. The top 5 drugs in terms of ROR and PRR are alemtuzumab, daclizumab, fludarabine, busulfan, and bendamustine in adults, with entecavir, treosulfan, vinorelbine, pegademase, and alemtuzumab for children. CONCLUSIONS Our study identified the most common drugs that could induce DIIHA in adults and children, as well as the respective ROR and PRR value to discover new drug signals. This study provides references to clinicians for the management of rare DIIHA.
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Affiliation(s)
- Linlin Tang
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Chuanhua Ding
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Hongying Li
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xueheng Zhou
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Guoqiang Yin
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
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9
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Tao E, Zhou H, Zheng M, Zhao Y, Zhou J, Yuan J, Yuan T, Zheng C. Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review. Front Pharmacol 2024; 15:1362668. [PMID: 38560354 PMCID: PMC10978768 DOI: 10.3389/fphar.2024.1362668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Ceftriaxone is widely used in pediatric outpatient care for its efficacy against respiratory and digestive system infections, yet its increasing association with severe immune hemolytic reactions requires heightened vigilance from pediatricians. This report details a rare and severe case of ceftriaxone-induced severe immune hemolytic anemia (IHA), hemolytic crisis, myocardial injury, liver injury, renal calculi, and cholecystolithiasis in a previously healthy 3-year-old child. The child, treated for bronchitis, experienced sudden pallor, limb stiffness, and altered consciousness following the fifth day of ceftriaxone infusion, with hemoglobin (Hb) levels precipitously dropping to 21 g/L. Immediate cessation of ceftriaxone and the administration of oxygen therapy, blood transfusion, intravenous immunoglobulin (IVIG), and corticosteroids led to a gradual recovery. Despite initial improvements, the patient's condition necessitated extensive hospital care due to complications including myocardial injury, liver injury, renal calculi, and cholecystolithiasis. After a 12-day hospital stay and a 3-month follow-up, the child showed complete normalization of Hb and liver function and resolution of calculi. In children, ceftriaxone infusion may trigger severe, potentially fatal, hemolytic reactions. Pediatricians must promptly recognize symptoms such as pallor, limb stiffness, and unresponsiveness, indicative of ceftriaxone-induced severe IHA, and immediately discontinue the drug. Effective management includes timely blood transfusion, respiratory support, IVIG administration, and corticosteroids when necessary, along with rigorous vital signs monitoring. Continued vigilance is imperative, even after cessation of ceftriaxone, to promptly address any residual adverse effects.
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Affiliation(s)
- Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Huangjia Zhou
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Meili Zheng
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Yisha Zhao
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Junfen Zhou
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Junhui Yuan
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Tianming Yuan
- Department of Neonatology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang Province, China
| | - Changhua Zheng
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
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10
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Kubo A, Murakami S, Iwata T. Drug Interaction-induced Hemolytic Anemia: An Unresolved Diagnostic Process. Intern Med 2024; 63:631-633. [PMID: 37438134 PMCID: PMC10982025 DOI: 10.2169/internalmedicine.2119-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Akihito Kubo
- Oncology Center, Aichi Medical University Hospital, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Japan
| | - Satsuki Murakami
- Oncology Center, Aichi Medical University Hospital, Japan
- Department of Hematology, Aichi Medical University, Japan
| | - Takashi Iwata
- Oncology Center, Aichi Medical University Hospital, Japan
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11
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Hansen DL, Frederiksen H. A leap in recognizing drug-induced immune hemolytic anemia. Blood Adv 2024; 8:815-816. [PMID: 38349669 PMCID: PMC11033611 DOI: 10.1182/bloodadvances.2023011842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Dennis Lund Hansen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Maquet J, Lafaurie M, Michel M, Lapeyre-Mestre M, Moulis G. Drug-induced immune hemolytic anemia: detection of new signals and risk assessment in a nationwide cohort study. Blood Adv 2024; 8:817-826. [PMID: 37782770 PMCID: PMC10874903 DOI: 10.1182/bloodadvances.2023009801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
ABSTRACT More than 130 drugs have been suspected to induce immune hemolytic anemia. Comparative studies measuring the risk of drug-induced immune hemolytic anemia (DIIHA) are lacking. We aimed (1) to detect new signals of DIIHA, excluding vaccines, and (2) to assess the association between all suspected drugs and the occurrence of immune hemolytic anemia in a nationwide comparative study. The new signals were identified using a disproportionality study (case/noncase design) in the World Pharmacovigilance Database, Vigibase, among the cases of adverse drug reactions reported up to February 2020 (>20 million). We then conducted a comparative study in the French National health database that links sociodemographic, out-of-hospital, and hospital data for the entire population (67 million individuals). Associations between exposure to drugs (those already reported as DIIHA, plus new signals identified in Vigibase) and incident cases of immune hemolytic anemia (D59.0 and D59.1 diagnosis codes of the International Classification of Diseases, version 10) from 2012 to 2018 were assessed with case-control and case-crossover designs. In Vigibase, 3371 cases of DIIHA were recorded. Fifty-nine new signals were identified resulting in a final list of 112 drugs marketed in France and measurable in the nationwide cohort (n = 4746 patients with incident immune hemolytic anemia included in the case-control analysis matched with 22 447 controls from the general population). We identified an association between immune hemolytic anemia occurrence and some antibiotics, antifungal drugs, ibuprofen, acetaminophen, furosemide, azathioprine, and iomeprol.
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Affiliation(s)
- Julien Maquet
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Marc Michel
- Department of Internal Medicine, National Reference Center for Adult Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hopitaux de Paris, University Paris-Est Créteil, Créteil, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
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13
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Schlatterer K, Marschner M, Hausdorf C. [In macrohematuria, medication history also needs to be considered : Penicillin-induced immune hemolysis: a case report and review of literature]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:1218-1223. [PMID: 37493757 DOI: 10.1007/s00108-023-01555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Drug-mediated immune hemolysis is a rare but potentially life-threatening condition. Based on a case of penicillin-induced immune hemolysis, a structured literature review of case reports and studies on penicillin-mediated Drug-Induced Immune Hemolytic Anemia (DIIHA) was carried out. CASE REPORT A 28-year-old male patient presented to the emergency department with gross hematuria and non-specific abdominal complaints. The patient had a 10-day history of respiratory infection with bacterial tonsillitis, treated orally with penicillin V on an outpatient basis. Laboratory diagnostics detected pathologically altered direct and indirect hemolysis parameters. After stopping the medication, the patient's condition could be stabilized. CONCLUSION Diagnosis of penicillin-mediated immune hemolysis requires structured cooperation between clinic and laboratory, as clinical and serological findings may be highly variable with the risk of misdiagnosis. Due to the rarity of the disease, this case report is intended to raise awareness with respect to the triad of abrupt drop in hemoglobin levels in connection with drug therapy and in combination with a strongly positive direct Coombs test.
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Affiliation(s)
- K Schlatterer
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland.
- Institut für Laboratoriumsmedizin, Sankt Gertrauden-Krankenhaus, Paretzer Str. 12, 10713, Berlin, Deutschland.
| | - M Marschner
- Abteilung für Innere Medizin/Kardiologie, Sankt Gertrauden-Krankenhaus, Berlin, Deutschland
| | - C Hausdorf
- Abteilung für Innere Medizin/Kardiologie, Sankt Gertrauden-Krankenhaus, Berlin, Deutschland
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14
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Barcellini W, Fattizzo B. Novel pharmacotherapy for drug-induced immune hemolytic anemia. Expert Opin Pharmacother 2023; 24:1927-1931. [PMID: 38037866 DOI: 10.1080/14656566.2023.2291075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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15
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Alebachew M, Gelaye W, Abate MA, Sime H, Hailgiorgis H, Gidey B, Haile M, Assefa G, Bekele W, Belay H, Parr JB, Tasew G, Mohammed H, Assefa A. Therapeutic efficacy of pyronaridine-artesunate (Pyramax ®) against uncomplicated Plasmodium falciparum infection at Hamusit Health Centre, Northwest Ethiopia. Malar J 2023; 22:186. [PMID: 37330475 PMCID: PMC10276904 DOI: 10.1186/s12936-023-04618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Early case detection and prompt treatment are important malaria control and elimination strategies. However, the emergence and rapid spread of drug-resistant strains present a major challenge. This study reports the first therapeutic efficacy profile of pyronaridine-artesunate against uncomplicated Plasmodium falciparum in Northwest Ethiopia. METHODS This single-arm prospective study with 42-day follow-up period was conducted from March to May 2021 at Hamusit Health Centre using the World Health Organization (WHO) therapeutic efficacy study protocol. A total of 90 adults ages 18 and older with uncomplicated falciparum malaria consented and were enrolled in the study. A standard single-dose regimen of pyronaridine-artesunate was administered daily for 3 days, and clinical and parasitological outcomes were assessed over 42 days of follow-up. Thick and thin blood films were prepared from capillary blood and examined using light microscopy. Haemoglobin was measured and dried blood spots were collected on day 0 and on the day of failure. RESULTS Out of 90 patients, 86/90 (95.6%) completed the 42-day follow-up study period. The overall PCR-corrected cure rate (adequate clinical and parasitological response) was very high at 86/87 (98.9%) (95% CI: 92.2-99.8%) with no serious adverse events. The parasite clearance rate was high with fast resolution of clinical symptoms; 86/90 (95.6%) and 100% of the study participants cleared parasitaemia and fever on day 3, respectively. CONCLUSION Pyronaridine-artesunate was highly efficacious and safe against uncomplicated P. falciparum in this study population.
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Affiliation(s)
- Mihreteab Alebachew
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P.O Box 1145, Dessie, Ethiopia
| | - Woyneshet Gelaye
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Megbaru Alemu Abate
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- The Unversity of Queensland, School of Public Health, Brisbane, Australia
| | - Heven Sime
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Henok Hailgiorgis
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Gudissa Assefa
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Habtamu Belay
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Jonathan B. Parr
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hussein Mohammed
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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16
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Wu Y, Wu Y, Guo G, Zeng J, Liu Y, Wu Y. Piperacillin-tazobactam induced immune hemolytic anemia led to increased renal impairment and eventual death from multiple organ failure in a patient with hypertensive nephropathy: case report and literature review. BMC Nephrol 2023; 24:173. [PMID: 37316798 DOI: 10.1186/s12882-023-03235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Piperacillin is one of the most common drugs that cause drug-induced immune hemolytic anemia, but a complete description of the serological features and course of the disease is rare. This study completely describes the serological characteristics and course of a patient with hypertensive nephropathy who developed drug-induced immune hemolytic anemia and worsened renal function during repeated administration of piperacillin-tazobactam. CASE PRESENTATION A 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia and worsened renal function during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection. Serological tests showed that the result of the direct antiglobulin test for anti-IgG was positive (4 +) and anti-C3d was negative, and the irregular red blood cell antibody screening test was negative. Plasma samples collected at different times from 2 days before to 12 days after the discontinuation of piperacillin-tazobactam administration were incubated with piperacillin solution and red blood cells of O-type healthy blood donors at 37 °C, IgG piperacillin-dependent antibodies were detected, and the highest titer was 128. However, no tazobactam-dependent antibody was detected in any plasma samples. Therefore, the patient was diagnosed with piperacillin-induced immune hemolytic anemia. Although blood transfusion and continuous renal replacement therapy were given, the patient died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped. CONCLUSION This is the first complete description of the disease course and serological changes of piperacillin-induced immune hemolytic anemia, which is bound to help deepen the understanding of drug-induced immune hemolytic anemia and draw profound lessons from it.
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Affiliation(s)
- Yong Wu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Yuanjun Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China.
- Department of Laboratory Medicine, Dongguan Maternal and Child Health Hospital, Dongguan Key Clinical Specialist, Dongguan, China.
| | - Ganping Guo
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Jiajun Zeng
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yan Liu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Yueqin Wu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
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17
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Bay P, Buob D, Modot T, Gabarre P, Doreille A, Rafat C. Antineoplastic drug-induced immune hemolytic anemia resulting in acute kidney injury: lesson for the clinical nephrologist. J Nephrol 2023:10.1007/s40620-023-01600-4. [PMID: 37017925 DOI: 10.1007/s40620-023-01600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Pierre Bay
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), 1 Rue Gustave Eiffel, 94010, Créteil, France
- UPEC (Université Paris Est), INSERM, Unité U955, équipe 18, 94010, Créteil, France
| | - David Buob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Anatomie et cytologie pathologiques, Paris, France
| | - Thomas Modot
- Etablissement Français du Sang, Ile de France, Hôpital Saint Antoine, Paris, France
| | - Paul Gabarre
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Saint Antoine, Réanimation Médicale, Paris, France
| | - Alice Doreille
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France
| | - Cédric Rafat
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Soins intensifs néphrologiques et rein aigu, Paris, France.
- Soins intensifs néphrologiques et Rein Aigu (SinRA), Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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18
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Delijewski M, Bartoń A, Maksym B, Pawlas N. The Link between Iron Turnover and Pharmacotherapy in Transplant Patients. Nutrients 2023; 15:nu15061453. [PMID: 36986181 PMCID: PMC10052361 DOI: 10.3390/nu15061453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Iron is a transition metal that plays a crucial role in several physiological processes. It can also exhibit toxic effects on cells, due to its role in the formation of free radicals. Iron deficiency and anemia, as well as iron overload, are the result of impaired iron metabolism, in which a number of proteins, such as hepcidin, hemojuvelin and transferrin, take part. Iron deficiency is common in individuals with renal and cardiac transplants, while iron overload is more common in patients with hepatic transplantation. The current knowledge about iron metabolism in lung graft recipients and donors is limited. The problem is even more complex when we consider the fact that iron metabolism may be also driven by certain drugs used by graft recipients and donors. In this work, we overview the available literature reports on iron turnover in the human body, with particular emphasis on transplant patients, and we also attempt to assess the drugs’ impact on iron metabolism, which may be useful in perioperative treatment in transplantology.
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Affiliation(s)
- Marcin Delijewski
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38, 41-808 Zabrze, Poland
- Correspondence: ; Tel.: +48-(32)-2722683
| | | | - Beata Maksym
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38, 41-808 Zabrze, Poland
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38, 41-808 Zabrze, Poland
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19
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Salim H, Musmar B, A Sarhan FM, Giacaman N, Abu Omar S. The First-Reported Case of Drug-Induced Hemolytic Anemia by Piperacillin-Tazobactam in a Premature Neonate: A Case Report and Literature Review. Cureus 2023; 15:e35915. [PMID: 37038577 PMCID: PMC10082334 DOI: 10.7759/cureus.35915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
Drugs can have a wide array of effects on hematological cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets. Drug-induced hemolytic anemia (DIHA) can be explained by three different pathophysiological mechanisms. We present a case of a premature neonate born at 34 weeks gestation who was admitted to the neonatal intensive care unit (NICU). He developed respiratory difficulty with mottled skin and was suspected to have bacterial sepsis due to necrotizing enterocolitis (NEC). The patient was eventually started on a broad-spectrum antibiotic, piperacillin-tazobactam. On day eight, the patient started developing jaundice and his hemoglobin level dropped from 12.1 to 8.2 mg/dL. His direct antiglobulin test (DAT) was strongly positive. The patient was suspected to have DIHA. Piperacillin-tazobactam is a commonly used antibiotic for neonatal sepsis, but its potential to cause DIHA in neonates is not well-established. Our case highlights the importance of considering piperacillin-tazobactam as an unrecognized contributor to neonatal jaundice and a potential cause of DIHA in neonates. Further research is needed to explore the extent of its involvement in this condition. Physicians should be cautious when administering this drug to neonates and be aware of the possibility of hemolysis and jaundice.
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20
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Green EA, Fogarty K, Ishmael FT. Penicillin Allergy. Prim Care 2023; 50:221-235. [PMID: 37105603 DOI: 10.1016/j.pop.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Allergy to penicillin can occur via any of the 4 types of Gel-Coombs hypersensitivity reactions, producing distinct clinical histories and physical examination findings. Treatments include penicillin discontinuation, and depending on the type of reaction, epinephrine, antihistamines, and/or glucocorticoids. Most beta-lactams may be safely used in penicillin-allergic patients, with the possible exception of first-generation and second-generation cephalosporins. Penicillin testing includes skin testing, patch testing, and graded challenge. The selection of the type of testing depends on the clinical setting, equipment availability, and type of hypersensitivity reaction. Desensitization may be used in some cases where treatment with penicillins is essential.
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Affiliation(s)
- Estelle A Green
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA
| | - Kelan Fogarty
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA
| | - Faoud T Ishmael
- Pennsylvania State University, College of Medicine University Park, 1850 East Park Avenue, State College, PA 16803, USA; Mount Nittany Health, 1850 East Park Avenue, State College, PA 16803, USA.
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21
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Ho IW, Huang CC. Furosemide-induced haemolytic anaemia in an extreme elderly patient. ESC Heart Fail 2023; 10:1449-1453. [PMID: 36652996 PMCID: PMC10053256 DOI: 10.1002/ehf2.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/17/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Furosemide, a loop diuretic, is commonly used to treat fluid overload symptoms and heart failure. Drug-induced immune haemolytic anaemia is an unusual drug-adverse event. Furosemide-induced haemolysis is even rarer. This case report presents a 91-year-old male who developed acute haemolytic anaemia 3 days after initiating furosemide to treat myocardial infarction complicated with acute decompensated heart failure. He had increased lactate dehydrogenase and unconjugated bilirubin with undetectable haptoglobin, which indicated the destruction of red blood cells. Other causes for haemolytic anaemia, including hereditary, microangiopathic haemolytic anaemia, and paroxysmal nocturnal haemoglobinuria, were also excluded. He improved with drug cessation and a short course of glucocorticoids. This report aims to raise awareness of this rare complication caused by commonly prescribed drugs. Despite a negative result of a direct antiglobulin test, physicians must remain suspicious of drug-induced immune haemolytic anaemia in unclear cases of haemolysis.
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Affiliation(s)
- I-Wei Ho
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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22
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Post-Artesunate Delayed Hemolysis: A Review of Current Evidence. Trop Med Infect Dis 2023; 8:tropicalmed8010049. [PMID: 36668956 PMCID: PMC9862382 DOI: 10.3390/tropicalmed8010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Artesunate is the drug of choice for treating patients with severe malaria. Post-artesunate delayed hemolysis (PADH) is an uncommon adverse event from malaria treatment. Most patients with PADH are non-immune travelers. The pathophysiology of PADH is not fully understood, but the most likely mechanism is "pitting", in which red blood cells carrying dead parasites killed by artesunate's action are directed to the spleen for clearing the dead parasites. After the cleansing process, these red blood cells re-enter the circulation but with a smaller size and impaired integrity, resulting in a shortened lifespan of 7-21 days. Therefore, most patients with PADH usually present with clinical features of hemolytic anemia 7 days or later after the initiation of artesunate. To date, the benefits of artesunate treatment outweigh its adverse events, and no fatal cases have resulted from PADH. However, the hematological follow-up of patients with malaria treated with artesunate is recommended for clinicians to detect any delayed hemolytic event early and prevent potentially serious consequences.
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23
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Ammon Shimano K, Noel P. Immunohematologic Disorders. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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24
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Ata F, Magboul HMB, Toba HAA, Alfar H, Al Bozom A, Murshed K, Zahid M. Rifampin-induced acute kidney injury and hemolysis: A case report and literature review of a rare condition. Clin Case Rep 2022; 10:e6780. [PMID: 36567686 PMCID: PMC9771787 DOI: 10.1002/ccr3.6780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/14/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Rifampicin is a bactericidal drug used in various infectious diseases, including tuberculosis (TB). Nephrotoxicity is a rare side effect of intermittent Rifampin use and even less commonly continued use. We report a case of Rifampin-induced acute tubular necrosis and hemolysis in a patient with latent TB with a relevant literature review.
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Affiliation(s)
- Fateen Ata
- Department of EndocrinologyHamad Medical CorporationDohaQatar
| | | | | | - Hadeel Alfar
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Adel Al Bozom
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Khaled Murshed
- Department of Anatomic PathologyHamad Medical CorporationDohaQatar
| | - Muhammad Zahid
- Department of Internal MedicineHamad Medical CorporationDohaQatar
- Weill Cornell MedicineDohaQatar
- College of MedicineQatar UniversityDohaQatar
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25
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V. Sunil S, Santosh Kumar HS, N. Pramod S, T. Prabhakar B, B.N. Naika M, G. Thippeswamy T, Niranjana P. Characterization and biochemical activities of novel functional antimicrobial peptide (AMP) from Trichogramma chilonis. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and Aim: The antimicrobial peptides (AMPs) are generally found in invertebrates, mammals, birds, plants and insects. AMPs produced by insect parasitoids contribute to innate immunity to resist infection due to lack of adaptive immunity. T. chilonis is one of the most effective endoparasitoid wasps for controlling lepidopterous insects. Several attempts have been made to isolate, characterize and develop a commercially viable product of AMPs from various insect sources. The present study aimed to characterize AMP from T. chilonis for potential antimicrobial and anti-cancer properties.
Methods: AMP was identified through T. chilonis transcriptome sequence and designed in silico and synthesized. Its purity was quantified using RP-HPLC, and the mass identified by mass spectrophotometry. LC/MS-MS was employed to predict the sequence and the BLAST program used to compare the sequence. AMP was tested for haemolytic activity and antimicrobial activity. Two pathogenic bacteria and fungal strains were used and IC50 values and MIC values were predicted against microbial strains.
Results: Synthetic peptide was found to be 95% homogenous with molecular weight of 3.48 kD. The peptide was identified to be a novel antimicrobial peptide consisting of 33 amino acid residues, and has a low computed instability index of -0.1.55 with high hydrophobic ratio of 27.27%. The antimicrobial activity revealed that T. chilonis antimicrobial peptide (TC-AMP) strongly inhibits the growth of selected human bacterial and fungal pathogens. While the haemolytic assay showed that the peptide did not obliterate human RBC in vitro. TC-AMP also showed an efficient inhibition of angiogenesis by in vivo model as evident by inhibition of vascularization.
Conclusions: AMP derived from the parasitoid has a potent antibiotic and anti-angiogenesis property. The peptide can be used as a potential antimicrobial and anticancer drug in near future with more detailed studies on its targeted applications.
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26
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Muacevic A, Adler JR. A Repeat Case of Cefotetan-Induced Hemolytic Anemia in a Surgical Patient. Cureus 2022; 14:e30675. [PMID: 36439576 PMCID: PMC9688886 DOI: 10.7759/cureus.30675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/25/2023] Open
Abstract
Drug-induced hemolytic anemia is a rare hematologic condition in which the immune system creates antibodies against red blood cell antigens in response to a medication exposure. This condition is commonly triggered by antibiotics, nonsteroidal anti-inflammatory drugs, and certain chemotherapies. Here, we describe a patient who experienced a repeat episode of drug-induced hemolytic anemia related to prophylactic cefotetan given before surgery. This case is important for increasing awareness of cephalosporin-induced hemolytic anemia, illustrating the significance of early detection and treatment of the condition, and highlighting the need for careful review of medication history in the surgical setting.
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27
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Lu H, Wang N, Wang P, Zhang H, Zhao R, Liu H, He X, Liu Z, Chang Y, Cao Y, Wang S. Case report: First case of pemetrexed plus cisplatin-induced immune hemolytic anemia in a patient with lung adenocarcinoma. Front Med (Lausanne) 2022; 9:917485. [PMID: 36091696 PMCID: PMC9452692 DOI: 10.3389/fmed.2022.917485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening drug-related complication. There are no previous reports of pemetrexed plus cisplatin as first-line chemotherapy for non-small cell lung cancer, resulting in DIIHA. Case presentation In this report, a patient with advanced-stage lung adenocarcinoma developed severe immune hemolytic anemia 21 days after pemetrexed plus cisplatin chemotherapy. Laboratory findings showed severe hemolysis, including a rapid decrease in hemoglobin (HGB) and an elevated level of reticulocytes (Rets), indirect bilirubin (IBIL), and lactate dehydrogenase (LDH). A workup for the possibility of DIIHA was performed, including a direct antiglobulin test (DAT), a test in the presence of the soluble drug, and a drug-treated red blood cell (RBC) test. It showed a strongly positive (3+) result for anti-C3d but not for anti-immunoglobin G (IgG) in DAT. Enzyme-treated RBCs reacted weakly with the patient's serum and pemetrexed when complement was added. In addition, the patient's serum and normal sera were reactive with cisplatin-treated RBCs. However, eluates from the patient's RBCs and diluted normal sera were non-reactive with cisplatin-coated RBCs. Untreated and enzyme-treated RBCs reacted with the patient's serum in the presence of soluble cisplatin. In vitro serological tests suggested that complement-dependent pemetrexed antibodies and cisplatin-associated non-immunologic protein adsorption (NIPA) might combine to cause immune hemolytic anemia. The patient's anemia gradually recovered when pemetrexed and cisplatin were discontinued. Conclusion This rare case demonstrated that complement-dependent pemetrexed antibodies and cisplatin-associated NIPA might occur simultaneously in a patient with DIIHA.
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Affiliation(s)
- Hongkai Lu
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Na Wang
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Peng Wang
- Department of Blood Transfusion, Peking University First Hospital, Beijing, China
| | - Haolin Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Ru Zhao
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Hongju Liu
- Clinical Laboratory, United Family Women's and Children's Hospital, Beijing, China
| | - Xirong He
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Zeya Liu
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Yue Chang
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Yongtong Cao
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Yongtong Cao
| | - Shiyao Wang
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Shiyao Wang
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Ishii H, Sato T, Ishibashi M, Yokoyama H, Saito T, Tasaki T, Yano S. A case of immune complex type hemolytic anemia by initial micafungin administration. Int J Infect Dis 2022; 122:755-757. [PMID: 35840096 DOI: 10.1016/j.ijid.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
We report the first case of immune complex type hemolytic anemia by initial micafungin administration that was given as prophylaxis to a 42-year-old Japanese man receiving chemotherapy for primary amyloidosis. The few cases found in the literature were associated with secondary administration to cause immune hemolysis attacks. Despite its rarity, the present case calls for increased awareness of micafungin-induced hemolytic anemia upon initial administration.
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Affiliation(s)
- Hiroto Ishii
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine.
| | - Tomohiko Sato
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Miyuki Ishibashi
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Hiroki Yokoyama
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Takeshi Saito
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Tetsunori Tasaki
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
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29
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Autoimmune Hemolytic Anemia: Diagnosis and Differential Diagnosis. Hematol Oncol Clin North Am 2022; 36:315-324. [DOI: 10.1016/j.hoc.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Pichler WJ, Watkins S, Yerly D. Risk Assessment in Drug Hypersensitivity: Detecting Small Molecules Which Outsmart the Immune System. FRONTIERS IN ALLERGY 2022; 3:827893. [PMID: 35386664 PMCID: PMC8974731 DOI: 10.3389/falgy.2022.827893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/26/2022] [Indexed: 12/19/2022] Open
Abstract
Drug hypersensitivity (DH) reactions are clinically unusual because the underlying immune stimulations are not antigen-driven, but due to non-covalent drug-protein binding. The drugs may bind to immune receptors like HLA or TCR which elicits a strong T cell reaction (p-i concept), the binding may enhance the affinity of antibodies (enhanced affinity model), or drug binding may occur on soluble proteins which imitate a true antigen (fake antigen model). These novel models of DH could have a major impact on how to perform risk assessments in drug development. Herein, we discuss the difficulties of detecting such non-covalent, labile and reversible, but immunologically relevant drug-protein interactions early on in drug development. The enormous diversity of the immune system, varying interactions, and heterogeneous functional consequences make it to a challenging task. We propose that a realistic approach to detect clinically relevant non-covalent drug interactions for a new drug could be based on a combination of in vitro cell culture assays (using a panel of HLA typed donor cells) and functional analyses, supplemented by structural analysis (computational data) of the reactive cells/molecules. When drug-reactive cells/molecules with functional impact are detected in these risk assessments, a close clinical monitoring of the drug may reveal the true incidence of DH, as suppressing but also enhancing factors occurring in vivo can influence the clinical manifestation of a DH.
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31
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Pichler WJ. The important role of non-covalent drug-protein interactions in drug hypersensitivity reactions. Allergy 2022; 77:404-415. [PMID: 34037262 PMCID: PMC9291849 DOI: 10.1111/all.14962] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
Drug hypersensitivity reactions (DHR) are heterogeneous and unusual immune reactions with rather unique clinical presentations. Accumulating evidence indicates that certain non‐covalent drug‐protein interactions are able to elicit exclusively effector functions of antibody reactions or complete T‐cell reactions which contribute substantially to DHR. Here, we discuss three key interactions; (a) mimicry: whereby soluble, non‐covalent drug‐protein complexes (“fake antigens”) mimic covalent drug‐protein adducts; (b) increased antibody affinity: for example, in quinine‐type immune thrombocytopenia where the drug gets trapped between antibody and membrane‐bound glycoprotein; and (c) p‐i‐stimulation: where naïve and memory T cells are activated by direct binding of drugs to the human leukocyte antigen and/or T‐cell receptors. This transient drug‐immune receptor interaction initiates a polyclonal T‐cell response with mild‐to‐severe DHR symptoms. Notable complications arising from p‐i DHR can include viral reactivations, autoimmunity, and multiple drug hypersensitivity. In conclusion, DHR is characterized by abnormal immune stimulation driven by non‐covalent drug‐protein interactions. This contrasts DHR from “normal” immunity, which relies on antigen‐formation by covalent hapten‐protein adducts and predominantly results in asymptomatic immunity.
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32
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Louvois M, Simon L, Pomares C, Jeandel PY, Demonchy E, Carles M, Delaunay P, Courjon J. Case Report: Autoimmune Hemolysis Anemia After Dihydroartemisinin and Piperaquine for Uncomplicated Plasmodium falciparum Malaria. Front Med (Lausanne) 2022; 8:756050. [PMID: 35111773 PMCID: PMC8801417 DOI: 10.3389/fmed.2021.756050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is still an endemic disease in Africa, with many imported cases in Europe. The standard treatment is intravenous artesunate for severe malaria and oral artemisinin-based combination therapy (ACT) for uncomplicated malaria. Delayed hemolytic anemia (DHA) after intravenous artesunate has been extensively described, and guidelines recommend biological monitoring until 1 month after the end of the treatment. A link with an autoimmune process is still unsure. Nevertheless, cases with positive direct antiglobulin test (DAT) have been reported. Conversely, DHA is not recognized as an adverse effect of oral ACT. Previously, only few cases of DHA occurring after oral ACT without intravenous artesunate administration have been reported. We report the case of a 42-year-old man returning from Togo. He was treated with dihydroartemisinin/piperaquine combination for uncomplicated Plasmodium falciparum malaria, with low parasitemia. Nine days after the end of the treatment, the patient developed hemolytic anemia with positive DAT. Eventually, the patient recovered after corticotherapy. After excluding common causes of autoimmune hemolytic anemia, we considered that dihydroartemisinin/piperaquine treatment was involved in this side effect.
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Affiliation(s)
- Marion Louvois
- Rheumatology, Université Côte d'Azur, CHU Nice, Nice, France
| | - Loïc Simon
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Christelle Pomares
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | | | - Elisa Demonchy
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Michel Carles
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Pascal Delaunay
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Johan Courjon
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
- *Correspondence: Johan Courjon
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Wu Y, Wu Y, Yang Y, Chen B, Li J, Guo G, Xiong F. Case Report: First Case of Cefotaxime-Sulbactam-Induced Acute Intravascular Hemolysis in a Newborn With ABO Blood Type Incompatibility by the Mechanism of Non-Immunologic Protein Adsorption. Front Immunol 2022; 12:698541. [PMID: 35003054 PMCID: PMC8727536 DOI: 10.3389/fimmu.2021.698541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background ABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN. Case presentation We report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother’s blood type was O and RhD-positive, and the newborn’s blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother’s plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent. In vitro experiments confirmed that NIPA of SBT promoted the specific binding of maternal-derived IgG anti-B to B antigen on RBCs of the newborn, thereby inducing acute intravascular hemolysis. Conclusion The NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn’s plasma to the newborn’s RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.
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Affiliation(s)
- Yuanjun Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yong Wu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Baochan Chen
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Jianqun Li
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Ganping Guo
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Fu Xiong
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Key Laboratory of Single Cell Technology and Application in Guangdong, Guangzhou, China
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34
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Sharma A, Chamberlain S, Mannuru D, Matta A. An Uncommon Incidence of Drug-Induced Immune Hemolytic Anemia Secondary to Ceftriaxone. Cureus 2021; 13:e20682. [PMID: 35106222 PMCID: PMC8786587 DOI: 10.7759/cureus.20682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
A 69-year-old female with a history of psoriatic arthritis was diagnosed with septic arthritis and started on broad-spectrum antibiotics. She underwent left hip excisional debridement of her prosthetic hip joint which grew group B Streptococcus (S. agalactiae). She was switched to IV ceftriaxone 2 g daily and her hemoglobin decreased to 5.4 g/dL on day 11. Peripheral blood smear showed normochromic normocytic anemia and thrombocytopenia without the presence of schistocytes. Increased lactate dehydrogenase (LDH), decreased haptoglobin and hemoglobin, and positive direct Coombs test (DCT) led to a presumptive diagnosis of drug-induced immune hemolytic anemia (DIIHA). As a result, she was switched from ceftriaxone to IV ertapenem 500 mg every 24 hours and oral prednisone 60 mg for four days during the initial phase. Her hemoglobin, LDH, and haptoglobin trended towards normal limits, further supporting the diagnosis of DIIHA secondary to ceftriaxone.
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35
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Mause E, Selim M, Velagapudi M. Cefazolin-induced hemolytic anemia: a case report and systematic review of literature. Eur J Med Res 2021; 26:133. [PMID: 34819145 PMCID: PMC8611989 DOI: 10.1186/s40001-021-00604-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cefazolin is a first-generation cephalosporin commonly used for skin and soft tissue infections, abdominal and orthopedic surgery prophylaxis, and methicillin-sensitive staph aureus. Cephalosporins as a whole are known potential inducers of hemolytic anemia; however, mechanism of action is primarily autoimmune, and compared to other drugs, cefazolin is the least common. Methods A rare case report of cefazolin-induced hemolytic anemia “CIHA” and a systematic review of CIHA articles in English literature. Two authors performed review of publications and articles were selected based on inclusion and exclusion criteria. A systematic search of the literature yielded 768 entries with five case reports on cefazolin-induced hemolytic anemia. Case presentation/results An 80-year-old female with methicillin-sensitive Staphylococcus aureus “MSSA” endocarditis. The patient was started on intravenous “IV” cefazolin that that resulted in hemolytic anemia and eosinophilia. Switching to vancomycin improved hemoglobin level and resolved eosinophilia. Four cefazolin-induced hemolytic anemia case reports and one population-based article with a case reported were analyzed with respect to direct antiglobulin test “DAT” (also known as the direct Coombs test) results, prior penicillin sensitivity, and acute anemia causes exclusion. Conclusions CIHA is a rare cause of clinically significant anemia. The diagnosis of drug-induced anemia is one of exclusion. It is important to consider DAT results and prior penicillin sensitivity when evaluating a patient for cefazolin-induced hemolytic anemia. However, the frequency of cefazolin use and resultant anemia necessitates early recognition of hemolytic anemia and prompt discontinuation of cefazolin, especially with long-term use.
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Affiliation(s)
| | - Mohammad Selim
- Department of Internal Medicine, Creighton University, Omaha, NE, USA
| | - Manasa Velagapudi
- Department of Infectious Disease, Creighton University, Omaha, NE, USA
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36
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Jacobs JW, Stump JA, Perez AN, Sharma D, Booth GS. Probable cefepime-induced immune mediated hemolytic anaemia. Transfus Med 2021; 31:503-504. [PMID: 34658061 DOI: 10.1111/tme.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jeremy W Jacobs
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey A Stump
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander N Perez
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deva Sharma
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Hematology-Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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37
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Wu Y, Wu Y, Ji Y, Liu Y, Wu D, Liang J, Guo G, Chen B. Case Report: Oral Cimetidine Administration Causes Drug-Induced Immune Hemolytic Anemia by Eliciting the Production of Cimetidine-Dependent Antibodies and Drug-Independent Non-specific Antibodies. Front Med (Lausanne) 2021; 8:723167. [PMID: 34646843 PMCID: PMC8504253 DOI: 10.3389/fmed.2021.723167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023] Open
Abstract
Previously, it was reported that multiple patients had hemolytic anemia associated with cimetidine administration, while only one patient who had received intravenous cimetidine was serologically diagnosed with drug-induced immune hemolytic anemia (DIIHA) caused by cimetidine-dependent antibodies. However, the ability of oral cimetidine intake to induce the production of antibodies has not been examined. In this study, we report a 44-year-old male patient in whom oral cimetidine administration resulted in cimetidine-dependent antibodies and drug-independent non-specific antibodies, leading to the development of DIIHA. Serological tests showed that the results of direct antiglobulin test (DAT) for anti-IgG (3+) and anti-C3d (1+) were positive. The IgM and IgG cimetidine-dependent antibodies (the highest total titer reached 4,096) were detected in the plasma incubated with O-type RBCs and 1 mg/mL cimetidine or the plasma incubated with cimetidine-coated RBCs. IgG-type drug-independent non-specific antibodies were detected in blood samples collected at days 13, 34, 41, and 82 post-drug intake. This is the first study to report that oral administration of cimetidine can elicit the production of cimetidine-dependent antibodies, leading to DIIHA, and the production of drug-independent non-specific antibodies, resulting in hemolytic anemia independent of cimetidine. Presence of pathogenic antibodies were detectable longer than 41 days. This suggests that patients with DIIHA caused by cimetidine need to be given necessary medical monitoring within 41 days after cimetidine intake.
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Affiliation(s)
- Yuanjun Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yong Wu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Yanhui Liu
- Dongguan Institute of Reproductive and Genetic Research, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Dongsheng Wu
- Department of Hematology, Dongguan Tungwah Hospital, Dongguan, China
| | - Jiajie Liang
- Dongguan Institute of Reproductive and Genetic Research, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Ganping Guo
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Baochan Chen
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
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38
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Stevens-Cohen P, Zaghi F, Zhu L. A Rare Case of Hydrochlorothiazide-Induced Hemolytic Anemia. Cureus 2021; 13:e17453. [PMID: 34589357 PMCID: PMC8464019 DOI: 10.7759/cureus.17453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Drug-induced immune hemolytic anemia is an exceedingly rare adverse drug event. Thiazide diuretics, commonly used in the treatment of primary hypertension, have been associated with this complication. In this case report, we present a 77-year-old male who developed acute hemolytic anemia two days after starting hydrochlorothiazide in the treatment of high blood pressure.
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Affiliation(s)
| | - Fardad Zaghi
- Internal Medicine, Coney Island Hospital, Brooklyn, USA
| | - Lawrence Zhu
- Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
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39
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Pankey AN, Chandar A, Isaacson G. Safety of Ibuprofen in Children With G6PD Deficiency: A Systematic Review. Laryngoscope 2021; 132:1300-1305. [PMID: 34546579 DOI: 10.1002/lary.29868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Ibuprofen is included on websites and frequently referenced lists as medium risk for inducing hemolysis in children with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This presents a challenge for otolaryngologists who perform tonsillectomy and other surgeries in children, as ibuprofen serves as an important alternative to opioids for perioperative pain control. We systematically review published literature and national medication databases to evaluate the risk of hemolytic anemia and related complications when ibuprofen is used in children with G6PD deficiency. METHODS Systematic literature review using preferred reporting items for systematic reviews and meta-analyses methodology. National drug adverse reaction database inquiry. RESULTS Our search yielded 774 results for review consideration. Of these, three studies were included in our final analysis (two retrospective case-series, and one nonrandomized prospective study). The prospective study showed no evidence of hemolysis from perioperative exposure to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) in children with G6PD deficiency at high risk. Two population studies in the Middle East suggested extremely low incidence of ibuprofen-related hemolysis (approximate 1/100,000 affected children per year). United States Food and Drug Administration (FDA), European Medicine Agency, and Health Canada adverse drug reaction databases reveled reported ibuprofen-related hematologic adverse reactions of approximate 1/100 million affected children per year. CONCLUSIONS There is scant, low-quality evidence of hemolytic anemia caused by ibuprofen in children with G6PD deficiency. If an association does exist, it is extremely rare. Drug-induced hemolytic anemias are recognizable and reversible following discontinuation of the inciting medication. Given these low risks, ibuprofen should be considered an appropriate choice in the management of perioperative pain in children with G6PD deficiency. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Ashley N Pankey
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Ashwin Chandar
- Section of Hematology and Thromboembolic Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A.,Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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40
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Wu Y, Wu Y, Ji Y, Liang J, He Z, Liu Y, Tang L, Guo G. Case Report: Drug-Induced Immune Haemolytic Anaemia Caused by Cefoperazone-Tazobactam/ Sulbactam Combination Therapy. Front Med (Lausanne) 2021; 8:697192. [PMID: 34485334 PMCID: PMC8415779 DOI: 10.3389/fmed.2021.697192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
There has previously been a report of a patient developing haemolytic anaemia following exposure to cefoperazone. Another case has been reported involving the detection of cefoperazone-dependent antibodies in the absence of immune haemolytic anaemia. To date, no serological evidence has been reported to suggest that cefoperazone can lead to drug-induced immune haemolytic anaemia (DIIHA). This report aims to fill these gaps in knowledge by describing a case of DIIHA caused by cefoperazone-dependent antibodies. A 59-year-old man developed fatal haemolytic anaemia while receiving cefoperazone-tazobactam or cefoperazone-sulbactam for the treatment of a lung infection that occurred after craniocerebral surgery. This eventually led to renal function impairment. Prior to the discontinuation of cefoperazone treatment, the patient showed strong positive (4+) results for both anti-IgG and anti-C3d direct antiglobulin test (DAT), while cefoperazone-dependent IgM and IgG antibodies were detected. The patient's plasma and O-type RBCs were incubated with tazobactam or sulbactam solution at 37°C for 3 h, the results of DAT for anti-IgG and anti-C3d were both positive. Forty-three days after the discontinuation of cefoperazone, the results of DAT for anti-IgG and anti-C3d were negative. Meanwhile incubation of the patient's fresh serum and his own RBCs with cefoperazone at 37°C, gave rise to mild haemolysis, and the results of DAT for both anti-IgG and anti-C3d were positive. It is suggested that cefoperazone-dependent antibodies can activate complement, and the non-immunologic protein adsorption effect of tazobactam or sulbactam can enhance IgG and complement binding to RBCs. This may promote the formation of immunocomplexes and complement activation, thereby aggravating haemolysis.
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Affiliation(s)
- Yuanjun Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yong Wu
- Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Jiajie Liang
- Dongguan Institute of Reproductive and Genetic Research, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Ziyi He
- Department of Transfusion Research, Dongguan Blood Center, Dongguan, China
| | - Yanhui Liu
- Dongguan Institute of Reproductive and Genetic Research, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Li Tang
- Department of Research, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Ganping Guo
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
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41
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Sharpe A, O'Keefe M, Windsor K, Theobald J, Feldman R. Hemolysis after subcutaneous deoxycholic acid overdose. Am J Emerg Med 2021; 52:268.e1-268.e2. [PMID: 34456101 DOI: 10.1016/j.ajem.2021.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022] Open
Abstract
This report describes a case of hemolysis in a patient injecting deoxycholic acid and benzyl alcohol for aesthetic benefit without medical supervision. The concentration and dose injected by the patient resulted in a 10-fold overdose of deoxycholic acid in comparison to the FDA-recommended dosing for the approved indication. Providers should be aware of medically unsupervised use of DCA and other injectables and the potential risks associated with this practice.
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Affiliation(s)
- Abigail Sharpe
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America.
| | - Mary O'Keefe
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
| | - Katie Windsor
- Concordia University Wisconsin School of Pharmacy; 12800 N Lake Shore Drive, Mequon, WI, 53097, United States of America
| | - Jillian Theobald
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
| | - Ryan Feldman
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
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42
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Park S, Song S, Baek J, Park H. Drug-Induced Immune Hemolytic Anemia Caused by Postoperative Cefotetan Administration. Ann Dermatol 2021; 33:384-386. [PMID: 34341644 PMCID: PMC8273326 DOI: 10.5021/ad.2021.33.4.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Seha Park
- Department of Dermatology, Gachon University Gil Medical Center, School of Medicine, Gachon University, Incheon, Korea
| | - Shinyoung Song
- Department of Dermatology, Gachon University Gil Medical Center, School of Medicine, Gachon University, Incheon, Korea
| | - Jinok Baek
- Department of Dermatology, Gachon University Gil Medical Center, School of Medicine, Gachon University, Incheon, Korea
| | - Hyangjoon Park
- Department of Dermatology, Gachon University Gil Medical Center, School of Medicine, Gachon University, Incheon, Korea
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43
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Kaleta M, Oklestkova J, Novák O, Strnad M. Analytical Methods for the Determination of Neuroactive Steroids. Biomolecules 2021; 11:553. [PMID: 33918915 PMCID: PMC8068886 DOI: 10.3390/biom11040553] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 12/27/2022] Open
Abstract
Neuroactive steroids are a family of all steroid-based compounds, of both natural and synthetic origin, which can affect the nervous system functions. Their biosynthesis occurs directly in the nervous system (so-called neurosteroids) or in peripheral endocrine tissues (hormonal steroids). Steroid hormone levels may fluctuate due to physiological changes during life and various pathological conditions affecting individuals. A deeper understanding of neuroactive steroids' production, in addition to reliable monitoring of their levels in various biological matrices, may be useful in the prevention, diagnosis, monitoring, and treatment of some neurodegenerative and psychiatric diseases. The aim of this review is to highlight the most relevant methods currently available for analysis of neuroactive steroids, with an emphasis on immunoanalytical methods and gas, or liquid chromatography combined with mass spectrometry.
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Affiliation(s)
| | - Jana Oklestkova
- Laboratory of Growth Regulators, Faculty of Science and Institute of Experimental Botany of the Czech Academy of Sciences, Palacký University, Šlechtitelů 27, CZ-78371 Olomouc, Czech Republic; (M.K.); (O.N.); (M.S.)
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44
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Pattanaik S, Jain A, Ahluwalia J. Evolving Role of Pharmacogenetic Biomarkers to Predict Drug-Induced Hematological Disorders. Ther Drug Monit 2021; 43:201-220. [PMID: 33235023 DOI: 10.1097/ftd.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Drug-induced hematological disorders constitute up to 30% of all blood dyscrasias seen in the clinic. Hematologic toxicity from drugs may range from life-threatening marrow aplasia, agranulocytosis, hemolysis, thrombosis to mild leukopenia, and thrombocytopenia. Pathophysiologic mechanisms underlying these disorders vary from an extension of the pharmacological effect of the drug to idiosyncratic and immune-mediated reactions. Predicting these reactions is often difficult, and this makes clinical decision-making challenging. Evidence supporting the role of pharmacogenomics in the management of these disorders in clinical practice is rapidly evolving. Despite the Clinical Pharmacology Implementation Consortium and Pharmacogenomics Knowledge Base recommendations, few tests have been incorporated into routine practice. This review aims to provide a comprehensive summary of the various drugs which are implicated for the hematological adverse events, their underlying mechanisms, and the current evidence and practical recommendations to incorporate pharmacogenomic testing in clinical care for predicting these disorders.
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Affiliation(s)
| | - Arihant Jain
- Internal Medicine, Hematology and Bone Marrow Transplantation, and
| | - Jasmina Ahluwalia
- Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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45
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Okumoto J, Sakamoto S, Masuda T, Yamaguchi K, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Fukushima N, Fujitaka K, Hamada H, Hattori N. Alectinib-induced Immune Hemolytic Anemia in a Patient with Lung Adenocarcinoma. Intern Med 2021; 60:611-615. [PMID: 32999219 PMCID: PMC7946499 DOI: 10.2169/internalmedicine.4241-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/16/2020] [Indexed: 11/06/2022] Open
Abstract
Drug-induced immune hemolytic anemia (DIIHA) is a rare condition with an increasing incidence associated with the frequent use of certain drugs. An 85-year-old woman with lung adenocarcinoma prescribed alectinib complained of dyspnea on exertion at our hospital. Based on her laboratory tests results on admission, we focused on the clinical course of anemia and hemolysis progression after alectinib administration. The patient's anemia and hemolysis gradually improved after discontinuation of alectinib, leading to a diagnosis of alectinib-induced IHA, presented here as the first case encountered in a patient with lung adenocarcinoma. Furthermore, we discuss the importance of correlating clinical laboratory findings in DIIHA.
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Affiliation(s)
- Joe Okumoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | | | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Hironobu Hamada
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Hiroshima University Hospital, Japan
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Esteves A, Teixeira da Silva F, Carvalho J, Carvoeiro A, Felgueiras P. Diclofenac-Induced Immune Hemolytic Anemia: A Case Report and Review of Literature. Cureus 2021; 13:e12903. [PMID: 33654588 PMCID: PMC7904503 DOI: 10.7759/cureus.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs are widely used for pain management. Most frequently, adverse reactions affect the gastrointestinal tract and hematological side effects usually relate to the gastrointestinal manifestations. Drug-induced immune hemolytic anemia is a rare and frequently underdiagnosed complication that is associated with poor outcomes including organ failure and even death. A 76-year-old female patient was treated with intramuscular diclofenac, thiocolchicoside, and diazepam for low back pain. Five days following diclofenac exposure, the patient was admitted to the Emergency Department with complaints of asthenia, nausea, vomiting, and diarrhea. Hemolysis and a positive direct antiglobulin test were detected on laboratory testing. Further causes of hemolytic anemia were excluded and a diagnosis of diclofenac-induced immune hemolytic anemia was established. Glucocorticoid therapy initiated on admission and drug eviction led to complete recovery. Long-term follow-up showed no recurrence of anemia. Here, we present the unusual case of a successful recovery of a 76-year-old patient with diclofenac-induced immune hemolytic anemia, a rare but immediate life-threatening condition of a frequently used drug in clinical practice.
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Affiliation(s)
- Alexandra Esteves
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | | | - José Carvalho
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Ana Carvoeiro
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Paula Felgueiras
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
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Afra F, Mehri M, Namazi S. Bosentan-induced immune hemolytic anemia in 17 years old man. A case report. ACTA ACUST UNITED AC 2021; 29:211-215. [PMID: 33486694 DOI: 10.1007/s40199-020-00386-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/29/2020] [Indexed: 01/22/2023]
Abstract
Hemolytic anemia is a very important immune-mediated reaction, which its late diagnosis can be fatal. Medications along with other causes can induce hemolytic anemia. Drug induced immune hemolytic anemia (DIIHA) is caused by the development of autoantibodies. Accordingly, DIIHA is rare and there is not enough data for its prevalence. Number of drugs that can cause DIIHA have increased in recent decades. A 17-year-old man who had congenital single ventricle heart (CHB) and pulmonary artery hypertension (PAH) was admitted at Imam Khomeini hospital complex affiliated to Tehran University of Medical Sciences, with chief complaint of jaundice and icter. Bosentan and Tadalafil were in the list of the drugs used by this patient. Although both drugs were recommended to be discontinued in the patient, in the course of hospitalization, the patient accidentally continued to take his Tadalafil. However, the patient's recovery continued. Given that the patient's Coombs test was positive, his hemolytic anemia mechanism was drug-induced immune-mediated hemolytic anemia. As a result, according to Naranjo score = 6, Bosentan was considered as the main possible culprit to induce DIIHA in this patient. Following the discontinuation of Bosentan and receiving Prednisolone, the patient's clinical symptoms and laboratory parameters resolved and the patient was then discharged.
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Affiliation(s)
- Fatemeh Afra
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Marjan Mehri
- Imam Khomeini Hospital, Department of Hematology and Oncology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Soha Namazi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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de Araújo CDSR, Machado BA, Fior T, Mattiello JM, Meinhart M, Bortolotti P, Brittes LLH, Pasqualotti A, Castilho L. Association of positive direct antiglobulin test (DAT) with nonreactive eluate and drug-induced immune hemolytic anemia (DIHA). Transfus Apher Sci 2020; 60:103015. [PMID: 33277206 DOI: 10.1016/j.transci.2020.103015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Drug-induced immune hemolytic anemia is a rare condition that occurs primarily because of drug-induced antibodies, either dependent or independent and positive direct antiglobulin test. Our aim was to evaluate the association of positive DAT with nonreactive eluate and DIHA. MATERIALS AND METHODS From 2014-2018, we evaluated 159 patients who presented positive DAT with a nonreactive eluate. Laboratory and clinical analyses were performed including HIV, HBV and HCV testing. All patients were exposed to the following drugs: Dipyrone in 63.5 %, Furosemide in 28.9 %, Metoclopramide in 34.6 % and Ondansetron in 41.5 %. RESULTS Results of DAT showed IgG in 125 (78.4 %) patients and C3d in 24 (15.1 %) with reactions varying from 1+ to 4+. HIV test was positive in 10 (16.1 %) patients, HBV was positive in 3 (4.7 %) and HCV was positive in, 1 (1.5 %). There was no clinical significance when the parameters of hemoglobin, hematocrit, reticulocytes and LDH were evaluated, only a slight increase in bilirubin, especially, in patients with positive DAT reacting 3+/4+ due to IgG and C3d sensitization. Clinical evaluations showed that all patients were asymptomatic. CONCLUSIONS The association of drugs with positive DAT can be a challenge to transfusion services and immunohematology reference laboratories. There was no evidence of any case of severe hemolysis with clinical repercussion through the clinical and laboratory findings analyzed with the drugs associated with positive DAT. Dipyrone and Furosemide have already been associated with DIHA but there are no studies reporting the association of Metoclopramide and Ondansetron with DIHA.
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Affiliation(s)
- Cristiane da Silva Rodrigues de Araújo
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, RS, Brazil; Serviço de Hemoterapia do Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil.
| | | | - Tamaris Fior
- Acadêmicos de medicina da Faculdade de medicina, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Júlia Mognon Mattiello
- Acadêmicos de medicina da Faculdade de medicina, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Mosseli Meinhart
- Acadêmicos de medicina da Faculdade de medicina, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Pillar Bortolotti
- Acadêmicos de medicina da Faculdade de medicina, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Adriano Pasqualotti
- Programa de Pós-Graduação em Envelhecimento Humano, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Lilian Castilho
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Michalak SS, Olewicz-Gawlik A, Rupa-Matysek J, Wolny-Rokicka E, Nowakowska E, Gil L. Autoimmune hemolytic anemia: current knowledge and perspectives. Immun Ageing 2020; 17:38. [PMID: 33292368 PMCID: PMC7677104 DOI: 10.1186/s12979-020-00208-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) is an acquired, heterogeneous group of diseases which includes warm AIHA, cold agglutinin disease (CAD), mixed AIHA, paroxysmal cold hemoglobinuria and atypical AIHA. Currently CAD is defined as a chronic, clonal lymphoproliferative disorder, while the presence of cold agglutinins underlying other diseases is known as cold agglutinin syndrome. AIHA is mediated by autoantibodies directed against red blood cells (RBCs) causing premature erythrocyte destruction. The pathogenesis of AIHA is complex and still not fully understood. Recent studies indicate the involvement of T and B cell dysregulation, reduced CD4+ and CD25+ Tregs, increased clonal expansions of CD8 + T cells, imbalance of Th17/Tregs and Tfh/Tfr, and impaired lymphocyte apoptosis. Changes in some RBC membrane structures, under the influence of mechanical stimuli or oxidative stress, may promote autohemolysis. The clinical presentation and treatment of AIHA are influenced by many factors, including the type of AIHA, degree of hemolysis, underlying diseases, presence of concomitant comorbidities, bone marrow compensatory abilities and the presence of fibrosis and dyserthropoiesis. The main treatment for AIHA is based on the inhibition of autoantibody production by mono- or combination therapy using GKS and/or rituximab and, rarely, immunosuppressive drugs or immunomodulators. Reduction of erythrocyte destruction via splenectomy is currently the third line of treatment for warm AIHA. Supportive treatment including vitamin supplementation, recombinant erythropoietin, thrombosis prophylaxis and the prevention and treatment of infections is essential. New groups of drugs that inhibit immune responses at various levels are being developed intensively, including inhibition of antibody-mediated RBCs phagocytosis, inhibition of B cell and plasma cell frequency and activity, inhibition of IgG recycling, immunomodulation of T lymphocytes function, and complement cascade inhibition. Recent studies have brought about changes in classification and progress in understanding the pathogenesis and treatment of AIHA, although there are still many issues to be resolved, particularly concerning the impact of age-associated changes to immunity.
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Affiliation(s)
- Sylwia Sulimiera Michalak
- Department of Pharmacology and Toxicology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland.
| | - Anna Olewicz-Gawlik
- Department of Anatomy and Histology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
- Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Poznan University of Medical Sciences, Poznan, Poland
- Department of Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Edyta Wolny-Rokicka
- Department of Radiotherapy, Multidisciplinary Hospital, Gorzów Wielkopolski, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
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50
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Boilève A, Gavaud A, Grignano E, Franck N, Carlotti A, Mira JP, Bouscary D, Jozwiak M. Acute and fatal cephalosporin-induced autoimmune haemolytic anaemia. Br J Clin Pharmacol 2020; 87:2152-2156. [PMID: 33075171 DOI: 10.1111/bcp.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022] Open
Abstract
We report the case of an 82-year old male patient admitted in our medical intensive care unit for diffuse skin lesions, 3 days after the onset of ceftriaxone for bilateral pneumonia without microbiological documentation. The patient concomitantly exhibited diffuse skin lesions compatible with livedo and neurological and haemodynamic failure. Biological analysis revealed acute haemolytic anaemia. Warming of patient, red blood-cells transfusion and high-doses corticosteroids were initiated and ceftriaxone was stopped. Despite these therapeutics, the patient exhibited multiple organ failure and died. The main suspected triggering factor of this acute and fatal haemolytic anaemia was ceftriaxone administration considering: (i) the delay between cephalosporin administration and symptoms; (ii) the worsening of livedo and acrocyanosis a few hours after meningeal ceftriaxone doses; and (iii) fatal evolution. Cephalosporin-induced autoimmune haemolytic anaemia is a rare and serious cause of livedo that should be suspected in patients exhibiting livedo and acute haemolytic anaemia within hours/days following cephalosporin administration.
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Affiliation(s)
- Alice Boilève
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France
| | - Ariane Gavaud
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France.,Université de Paris, Paris, France
| | - Eric Grignano
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.,Université de Paris, Paris, France
| | - Nathalie Franck
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Dermatologie, Paris, France
| | - Agnès Carlotti
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Anatomo-Pathologie, Paris, France
| | - Jean-Paul Mira
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France.,Université de Paris, Paris, France
| | - Didier Bouscary
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.,Université de Paris, Paris, France
| | - Mathieu Jozwiak
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France
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