Haemolysis, drug-induced

Drug-induced haemolysis and renal failure in children with gIucose-6-phosphate dehydrogenase deficiency in Afghanistan. 

Drug-induced haemolysis in glucose-6-phosphate dehydrogenase deficiency. 

Ohata reported that the simultaneous intramuscular administration of aminopyrine and barbital resulted in a high plasma level by the formation of a molecular ccxnpound conpared with single administration of the conponents (2,3). Further, Pitha et al. reported that the toxic effect increased and set in rapidly without symptoms of hypervitami-nosis A when dimethyl- 3 CD was administered simultaneously with retinoic acid, and the survival rate was improved when dimethyl-3-CD was administered alone after the hypervitaminosis A had been established (4). It has also been reported that CDs have such advantages as removal of local irritation induced by intramuscular injection (5), protection of a drug-induced haemolysis (6), and so on. 

In Hb Zurich, the E 7 (63 fi) distal histidine is replaced by arginine at the same site the replacement by tyrosine in Hb M Saskatoon favours the oxidation to methaemoglobin. The following drugs inducing haemolytic reactions in G-6-PD deficiency are also found to cause haemolysis of red cells which contain Hb Zurich sulphisoxazole, sulphisomidine, sulphadimethoxine. sulphamerazine. sulphamethoxy-pyridazine, primaquine and other oxyquinolines. 

Type II reactions are mimicked by the haemolysis induced by drugs (some antimalarials, sulpho-namides and oxidising agents) and food (broad beans) in subjects with inherited abnormahties of erythrocyte enzymes or haemoglobin (see p. 123). 

A false-pathological elevation of the bilirubin concentration can be induced by fasting (>24 hrs.), intense muscular activity, haemolysis and certain drugs (e.g. antibiotics, propranolol, methyldopa and oestrogen). 

Salama A, Gottsche B, Mueller-Eckhardt C. Autoantibodies and drug- or metabolite-dependent antibodies in patients with diclofenac-induced immune haemolysis. Br J Haematol 1991 77(4) 546-9. 

As excipients, CDs have been widely used to cover the bitter taste of drugs, to increase their dissolution rates, to reduce irritation reactions and in low concentrations to suppress the haemolysis induced by some drugs [180]. Great effort has been made to develop CD-based drug formulations with different administrative routes, including parenteral, oral, pulmonary, nasal [181], transdermal, rectal [182] and ophthalmic [183] drug delivery [184]. 

In between 5 and 30% of cases treated with a-methyldopa for more than 6 months a positive Coombs test can be found. High dosage favours its development. In only 0.5—3% of these cases does a haemolytic anaemia develop at any time, the clinical picture often being precipitated by an intercurrent illness (3, 7 IF, 12, 18, 3V). In such cases, besides the positive Coombs test, typical warm reactive IgG antibodies are found which react with normal red cells in the absence of the drug. As in idiopathic IgG-induced warm reactive haemolysis the antibody is directed against the rhesus nucleus substance and the principal site of haemolysis is the spleen (38, 39, 40 ). 

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