Hemolysis rifampicin

Hemolysis (34,35), agranulocytosis (36), leukopenia (37), and thrombocytopenia (38) have been reported in patients taking rifampicin (SED-10, 578) and constitute contraindications to continuation of therapy. 

Isolated cases of massive hemolysis, with or without renal insufficiency, have been observed in patients taking rifampicin (42 4). Whereas rifampicin given repeatedly and in the usual dose is quite safe, it can cause intravascular hemolysis when given intermittently (45). 

In one case, hemolysis started after the second dose of rifampicin, and the patient s blood contained rifampi-cin-dependent IgG and IgM antibodies, which caused erythrocyte lysis through an interaction with the I antigen on the erythrocyte surface (35). This antigen is also expressed on renal tubular epithelium and the hemolysis was accompanied by acute renal insufficiency. 

Diamond JR, Tahan SR. IgG-mediated intravascular hemolysis and nonoUguric acute renal failure complicating discontinuous rifampicin administration. Nephron 1984 38(l) 62-4. 

Tahan SR, Diamond JR, Blank JM, Horan RF. Acute hemolysis and renal failure with rifampicin-dependent antibodies after discontinuous administration. Transfusion 1985 25(2) 124-7. 

Hematologic Two patients developed severe intravascular hemolysis during daily low-dose rifampicin treatment of meticil-lin-resistant Staphylococcus aureus (MRSA) [82 ]. 

Hemolytic anemia associated with rifampicin was hypothesized to be hapten mediated, as the patient s serum fixed complement in the presence of rifampicin. However, subsequent studies identified circulating erythrocyte-specific antibodies in the serum with specificity for both the Lutheran (Lu) and I antigens. The presence of the I antigen on the surface of leukocytes, platelets, and renal tubular epithelial cells may have accounted for the hemolysis, thrombocytopenia, and renal failure with acute tubular damage observed in the first patient. 

Manika K, Tasiopoulou K, Vlogiaris L, Lada M, Papaemmanouil S, Zarogoulidis K, et al. Rifampicin-associated acute renal failure and hemolysis a rather uncommon but severe complication. Ren Fail 2013 35(8) 1179-81. 

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