Interferon alfa hemolytic anemia

Capsules/Tablets/Oral solution-There are significant adverse events caused by ribavirin capsules/interferon alfa-2b or peginterferon alfa-2b therapy, and ribavirin tablets/peginterferon alfa-2a therapy, including severe depression and suicidal ideation, hemolytic anemia, suppression of bone marrow function, autoimmune and infectious disorders, pulmonary dysfunction, pancreatitis, and diabetes. 

Interferon alfa has direct myelosuppressive effects and can also cause hematological disorders by immune blood cell destruction, as suggested by reports of immune-mediated thrombocytopenia, immune hemolytic anemia (205,206), or a positive direct Coombs test, with or without hemolysis (207-209). 

Rapid exacerbation (1-21 days) or delayed (3-38 months) de novo appearance of immune hemolytic anemia has been reported after initiation of interferon alfa treatment in nine patients with lymphoproliferative disorders (220). However, this rare event was identified in only 1% of 581 patients receiving interferon alfa alone or as part of a chemotherapeutic regimen for chronic myelogenous leukemia (221). A mechanism close to that observed with alpha-methyldopa has been thought to be involved (208). The direct antiglobulin test was positive in 32% of 28 chronic myeloid leukemia patients after a median of 1 year of treatment with interferon alfa (222). 

The combination of interferon alfa with ribavirin is one of the most promising treatments for chronic hepatitis C. However, two patients developed rapid and particularly severe anemia within 4 and 6 weeks of combined treatment (415). One patient required erythrocyte transfusions, and both recovered after withdrawal. The combination of pure red cell aplasia due to interferon alfa and hemolytic anemia due to ribavirin was suggested to have accounted for this possible interaction. 

Ribavirin 15 mg/kg/day pins interferon alfa in 12 teenagers has been compared with interferon alone in 10 (11). There was no difference in dropont rate, bnt viral clearance was achieved in 50% of the patients who took the combination treatment versns 30% of those who took monotherapy. Adverse events were similar in the two groups. There was mild hemolytic anemia at the end of the first month in most of the children who took ribavirin,... 

Ribavirin accnmnlates in erythrocytes, resnlting in hemolysis by an nnknown mechanism, perhaps related to oxidative damage to the erythrocyte membrane. Time-dependent and dose-dependent hemolytic anemia (eventnaUy associated with hyperbilirubinemia and a high reticnlocyte connt) is the only major toxic effect associated with oral or intravenons ribavirin and is reversible on withdrawal. There was a fall in hemoglobin concentrations below 10.0 g/dl in 9% of patients with hepatitis C treated with ribavirin and interferon alfa (6,7). 

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See also in sourсe #XX -- [ ]

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