Paracetamol anemia

A 58-year-old man took sirolimus 8mg/m /day for severe psoriasis with arthritis. He also took ibuprofen, co-trimoxazole, and paracetamol. Within 1 month he developed nocturnal fever, dizziness, orthostatic hypotension, leg edema, and anemia. All his symptoms subsided after sirolimus withdrawal, furosemide treatment, and erythrocyte transfusion. 

It is an analgesic and an antipyretic with similar effectiveness as aspirin. It has a greater potential for toxieity (hemolytic anemia and methemoglobinemia) than paracetamol. Irreversible kidney damage with prolonged ingestion of phenacetin has been established whieh ultimately resulted in complete withdrawal of this drug in many countries. 

Anti-D immunoglobulin is used as an alternative to intravenous immunoglobulin to treat idiopathic thrombocytopenic purpura. Patients treated with anti-D immunoglobulin (WinRho ), in contrast to earlier published reports, had more adverse reactions, particularly chills and rigors, despite pretreatment with paracetamol and diphenhydramine [66 ]. Two patients needed treatment for severe anemia and one for severe hemoglobinuria. Pretreatment with glucocorticoids or the use of subcutaneous anti-D immunoglobulin may reduce transfusion-related adverse reactions. However, the... 

In relation to the administration of medicines for animals, the pharmacological differences and local laws have to be observed. The pharmacokinetics of every active substance is different in each species. For anunals, especially cats, the toxic concentration of many human medicines is lower than the therapeutic dose in humans due to differences in metabolism of medicines. For example, in cats, the administratirm of acetaminophen (paracetamol) very quickly leads to intoxication with methemoglobin formation, anemia, hemoglobinuria and liver damage, as they may metabolise the medicine poorly. 

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