Quinidine hemolytic anemia with

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. 

Thrombocytopenia is a well-recognized hypersensitivity reaction, inducible by quinidine, but only about 50 cases have been reported (Robinson 1978). Hemolytic anemia is even more rare one well-documented case was reported by Freedman et al. (1956) and one case of agranulocytosis with marrow depression was reported by Barzel (1967). 

Hemolytic anemia is particularly associated with quinidine and methyldopa. The one case induced by quinidine (Freedman et al. 1956) was in a 69-year-old male with a past history of syphilis who developed signs of a purpuric eruption 4 days after starting treatment. The patient was treated with adrenocorticotrophic hormone and the red blood cell count had returned to normal by day 20. 

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