Drug induced hemolytic anemia

Autoimmune chronic active hepatitis Autoimmune hemolytic anemia, drug-induced SLE, myasthenia gravis, pemphigus, glomerulonephritis, Goodpasture s disease... 

Examples of type II cytotoxic antibody-mediated drug reactions include drug-induced immune hemolytic anemia, drug-induced thrombocytopenia where a number of different mechanisms are involved and acute agranulocytosis in which more than 70 % of cases are caused by drugs... 

Type II, or cytolytic, reactions are mediated by both IgG and IgM antibodies and usually are attributed to their ability to activate the complement systerrr The major target tissues for cytolytic reactions are the cells in the circulatory system. Examples of type II allergic responses include penicillin-inhemolytic anemia, methyldopa-indMced autoimmune hemolytic anemia, quinidine-induced thrombocytopenic purpura, and sulfonamide-induced granulocytopenia. These autoimmune reactions to drugs usually subside within several months after removal of the offending agent. 

Rare cases of hemolytic anemia, including fatalities, have been reported with the administration of the cephalosporins. The patient should be monitored for anemia If a patient experiences anemia within 2 to 3 weeks after the start of cephalosporin therapy, drug-induced anemia should be considered. If hemolytic anemia is suspected, the primary health care provider will discontinue the drug therapy. The patient may require blood transfusions to correct tire anemia. Frequent hematological studies may be required. 

The answer is a. (Katzung, p 162.) Many drugs can cause an immunohemolytic anemia. Methyldopa may cause a positive Coombs test in as many as 20% of patients, along with hemolytic anemia. Other drugs with similar actions on red blood cells are penicillins, quinidine, procainamide, and sulfonamides. These form a stable or unstable hapten on the red cell surface, which induces an immune reaction I immunoglobulin G (IgG) antibodies] and leads to dissolution of the membrane. 

In contrast to a-methyldopa-induced hemolytic anemia, most drug-induced hemolytic anemia, especially for penicillins [34] and cephalosporins [35], involves drug-dependent antibodies, presumably because the drug acts as a hapten to directly modify erythrocytes or form immune complexes [36], However, there are many examples where a drug, such as nomifensine, induces both drug- (or metabolite)-dependent and drug-... 

Bll. Beutler, E., Drug-induced hemolytic anemia (Primaquine sensitivity). In The Metabolic Basis of Inherited Disease (J. B. Stanbury, J. B. Wyngaarden, and D. S. Fredrickson, eds.), pp, 1031-1067. McGraw-Hill, New York, 1960. 

G19. Gross, R. T., and Marks, P. A., An hereditary enzymatic defect in red blood cells Its relation to certain drug induced hemolytic anemias. Ann. N.Y. Acad. Sci. 75, 100-109 (1958). 

Szeinberg, A., Sheba, C., and Adam, A., Enzymatic abnormality of a population sensitive to Vida faba or hemolytic anemia induced by drugs. Nature 181, 1256 (1958). 

Szeinberg, A., Sheba, C., Hirshom, N., and Bodonyi, E., Studies on erythrocytes in cases with past history of favism and drug induced hemolytic anemia. Blood 12, 603-613 (1957). 

Antibiotics Isoniazid Penicillins Hypersensitivity and Autoimmunity Rash, dermatitis, vasculitis, arthritis, drug-induced SLE Anaphylaxis, dermatitis vasculitis, serum sickness, hemolytic anemia... 

Sulfonamides Dermatitis, photosensitivity pemphigus, hemolytic anemia, serum sickness, drug-induced SLE... 

Autoantibodies to red blood cells and autoimmune hemolytic anemia have been observed in patients treated with numerous drugs, including procainamide, chlor-propaminde, captopril, cefalexin, penicillin, and methyldopa (Logue et al., 1970 Kleinman et al., 1984). Hydralazine- and procainamide-induced autoantibodies may also result in SLE. Approximately 20% of patients administered methyldopa for several weeks for the treatment of essential hypertension developed a dose-related titer and incidence of autoantibodies to erythrocytes, 1% of which presented with hemolytic anemia. Methlydopa does not appear to act as a hapten but appears to act by modifying erythrocyte surface antigens. IgG autoantibodies then develop against the modified erythrocytes. 

Episodic hemolytic anemia (most common) induced by infection and drugs... 

Finally, the successful use of vincristine in the treatment of drug-induced microangiopathic hemolytic anemia, a disease resembling the hemolytic uremic syndrome rarely seen subsequent to administration of mitomycin C or other chemotherapy has been described in two patients with this disorder (79). 

Contraindications Impaired renal orhepaticfunction, history of drug-induced hemolytic anemias or other anemias, history of hypersensitivity to metaxalone... 

Approximately 30% of patients using sulfasalazine discontinue the drug because of toxicity. Common adverse effects include nausea, vomiting, headache, and rash. Hemolytic anemia and methemoglobinemia also occur, but rarely. Neutropenia occurs in 1-5% of patients, while thrombocytopenia is very rare. Pulmonary toxicity and positive double-stranded DNA are occasionally seen, but drug-induced lupus is rare. Reversible infertility occurs in men, but sulfasalazine does not affect fertility in women. The drug does not appear to be teratogenic. 

Certain autoimmune syndromes can be induced by drugs. Examples include systemic lupus erythematosus following hydralazine or procainamide therapy, "lupoid hepatitis" due to cathartic sensitivity, autoimmune hemolytic anemia resulting from methyldopa administration, thrombocytopenic purpura due to quinidine, and agranulocytosis due to a variety of drugs. As indicated in other... 

Rarely reported hematological reactions to various neuroleptic drugs include agranulocytosis, thrombocytopenic purpura, hemolytic anemia, leukopenia, and eosinophilia. These are thought to represent allergic or hypersensitivity reactions, although this has been questioned in one detailed case report of chlorpromazine-induced agranulocytosis (514). 

Oral use of sulfonamides, pyrimethamine, and trimethoprim can canse blood dyscrasias such as hemolytic anemia, aplastic anemia, lenkopenia, and agran-nlocytosis. Becanse these blood changes are due to a drug-induced folic acid deficiency, administering folinic (not folic) acid can coimteract the toxicity. Use of folinic acid bypasses the need fc>r dihydrofolate reductase by supplying the fully reduced folate. 

Garratty G, Petz LD. Drug-induced immune hemolytic anemia. Am J Med 1975 58(3) 398 07. 

Worlledge SM. Immune drug-induced hemolytic anemias. Semin Hematol 1973 10(4) 327-44. 

Autoimmune hemolytic anemia has rarely been reported with the older cephalosporins, including cefalexin (40), cefalotin (41,42), cefazolin (43), and cefaloridine (44). The main laboratory findings correspond to the drug adsorption mechanism classically found in benzylpenicil-lin-induced immune hemolysis. Antibodies cross-reacting with cefalotin and benzylpenicillin were found in both benzylpenicillin-induced and cefalotin-induced hemolysis (43,45) Cases have also been reported with cefamandole (46), cefalexin (47), ceftriaxone (48), cefotaxime (49,50), cefotetan (51,52) and ceftazidime (53). 

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