Drug induced anemia pdf

These drugs bind to the surface of red blood cells and stimulate the immune system to produce antibodies directed at the drug itself or at an epitope created by the combination of drug and rbc membrane. Drug induced aplastic anemia accounts for 7% to 86% of total cases of aplastic anemia. The remaining eluate was differentially tested against all reagents in previous reaction mixtures, as well as piperacillin. Druginduced folate deficiency the national academies press.

Removal of the offending drug is the primary treatment for drug induced oxidative hemolytic anemia. The ha can be caused by drugindependent antibodies that are indistinguishable, in vitro and in vivo, from autoantibodies causing. Alcohol has numerous adverse effects on the various types of blood cells and their functions. Ingestion of any of a large number of drugs is followed by immunization and the formation of a soluble drugantidrug complex that adsorbs. Druginduced immune haemolytic anaemia diha is a rare complication of drug treatment and has an estimated incidence of approximately 14 cases per million individuals per year 1,2. Pdf drug induced immune hemolytic anemia researchgate. Druginduced immune hemolytic anemia hematology american. It is this crucial role of dihydrofolate reductase in thymidine nucleotide biosynthesis that makes it a target for antineoplastic thera. Drug induced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the bodys defense immune system to attack its own red blood cells. The mechanisms of druginduced anemia can be explained in terms of either direct immune reaction or drug or metabolite toxicity. However, when a patient develops hemolysis that may be drug induced, there are several challenges in evaluation and management including determining whether a drug is responsible, which drug is the likely culprit, and whether additional interventions are indicated other than stopping the drug.

Drug induced hemolytic anemia is a very rare but potentially lethal adverse drug reaction, which can take the form of oxidative damage to vulnerable erythrocytes as in glucose6phosphate dehydrogenase deficiency, drug induced thrombotic microangiopathy, or immunemediated hemolytic anemia. It is this crucial role of dihydrofolate reductase in thymidine nucleotide biosynthesis that makes it a. The ha can be caused by drug independent antibodies that are indistinguishable, in vitro and in vivo, from. The consulting pathologist plays a critical role in integrating serologic findings with the clinical history, as drug induced antibodies should be distinguished as either drug dependent or drug independent for appropriate clinical management. In a few instances antibodies have been implicated clearly in drug reactions affecting the blood, 1 but more often this approach has been unrewarding. Biochemical investigations of drug induced hemolytic anemias have clarified the mechanism of sensitivity in this disorder. There are good data for druginduced thrombocytopenia 1018 cases per million 1,2 and neutropenia 215 cases per million,3 but only guesses for diiha. An antibody which reacted like the antibodies found in autoimmune hemolytic anemia was present in the patients serum and eluted from the coombspositive erythrocytes. This page includes the following topics and synonyms. Biochemical investigations of druginduced hemolytic anemias have clarified the mechanism of sensitivity in this disorder. Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. Two cases of coombspositive druginduced hemolytic anemia are presented. Coombspositive druginduced hemolytic anemia american. When certain drugs that are not toxic to the majority of the population are given to a few sensitive persons, marked hemolytic anemia occurs.

It may be drug induced, for example in cats and dogs by acetaminophen paracetamol, or may be caused by eating various plants or other substances. Druginduced immune hemolytic anemia diiha is a rare occurrence 1 in 1 million and is characterized by a decrease in hemoglobin following drug treatment. Druginduced hemolytic anemia is a very rare but potentially lethal adverse drug reaction, which can take the form of oxidative damage to vulnerable erythrocytes as in glucose6phosphate dehydrogenase deficiency, druginduced thrombotic microangiopathy, or immunemediated hemolytic anemia. Drug induced aplastic anemia was initially reported in the 1930s. Druginduced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the bodys defense immune system to attack its own red blood cells. If you need to print pages from this book, we recommend downloading it as a pdf. Sep 15, 2018 hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. Pdf we studied the presence of drugdependent antibodies ddabs in 53 patients with aids who developed immune hemolytic anemia. This study investigated the possibility of drug aetiology of immune haemolytic anaemia iha in 4 patients with new onset of iha who were identi. Pathology consultation on druginduced hemolytic anemia. Jan 01, 2009 druginduced immune hemolytic anemia diiha is rare.

Anemia is defined as a decrease in the concentration of the hemoglobin depending upon the age and the sex of the patient. Pdf on jan 1, 2017, monica khurana and others published druginduced hemolytic anemia. Drugs that are innocuous to many patients result in untoward reactions in a few sensitive persons. This is in part due to the fact that such changes are not readily obtainable with laboratory animals, while. One case was associated with the prolonged administration of methyldopa aldomet.

Druginduced immune haemolytic anaemia is a rare but serious condition. Unfortunately, this book cant be printed from the openbook. Anemia is indicated by a low hemoglobin andor hematocrit. Druginduced immune hemolytic anemia diiha is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. Drug induced anaemia is a condition in which the body does not have enough healthy red blood cells resulting from the administration of a drug. Some authors have reported a peak incidence in patients younger than 30 years of age, although others report the. Some examples of medications that could cause the condition are. In investigating the possibility of a druginduced hemolytic anemia, one must consider not only the prescription medications that the patient is taking, but also overthecounter medications and even possible chemical exposures. It manifests if the production of the erythrocytes in the bone marrow is slower than their degradation. It should be part of the differential diagnosis for any normocytic or. Drug induced megaloblastic anemia tion of serine hydroxymethyl transferase. Symptoms of hemolytic anemia can include fatigue, malaise, pallor, and shortness of breath. Fludarabine and hemolytic anemia drug antibodies drug induced immune hemolytic anemia diiha is rare. Syndromes of thrombotic microangiopathy tma, defined by microangiopathic hemolytic anemia, thrombocytopenia, and microvascular thrombosis with characteristic vessel wall abnormalities, have multiple etiologies.

Drug induced immune haemolytic anaemia diha is a rare complication of drug treatment and has an estimated incidence of approximately 14 cases per million individuals per year 1,2. Supplements to overcome these effects or discontinuation of the drug may be necessary. Anemia types and characteristic finding classification of. Drug induced immune hemolytic anemia diiha is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the. Druginduced aplastic anemia is one of the few lifethreatening reactions to drugs. If dihy drofolate is not reduced and methylated, the cell is starved of thymidylate, and dna synthesis slows. Chemotherapyinduced anemia cia is a multifaceted entity influenced by a variety of patient and treatmentspecific factors. Variability of findings in druginduced immune haemolytic. Acquired hemolytic anemia an overview sciencedirect topics. The incidence of druginduced immune thrombocytopenia and neutropenia is quite well documented 10 to 18 and 2 to 15 cases per million, respectively, 1, 3 but there are no good data for diiha.

The onset of druginduced hemolytic anemia is variable and depends on the drug and mechanism of the hemolysis. Three distinct types of mechanism that render red cells sensitive to druginduced hemolysis have been delineated. In investigating the possibility of a drug induced hemolytic anemia, one must consider not only the prescription medications that the patient is taking, but also overthecounter medications and even possible chemical exposures. Drug category nutrients depleted repletion suggestions. Anemia is indicated by low hemoglobin andor hematocrit.

Drug induced immune haemolytic anaemia in the berlin case. Drug induced immune hemolytic anemia diiha is rare. Aplastic anemia occurs when the bone marrow fails and production of red blood cells, white cells, and platelets ceases i. Drugs has become a more prominent cause of megaloblastic anemia because most of the dietary causes of folate and vitamin b12 defi ciency. Drug induced hematologic disorders can affect any cell line, including white blood cells wbcs, red blood cells rbcs, and platelets. Druginduced megaloblastic anemia tion of serine hydroxymethyl transferase. In some instances, hemolytic anemia is the result of taking certain medications. Druginduced hemolytic anemia, medication causes of hemolytic anemia, drug induced immunemediated hemolysis, druginduced immune hemolytic anemia, druginduced autoimmune hemolytic anemia, druginduced thrombotic microangiopathic anemia. Recent publications have emphasized the close etiological relationship of erythrocyte glucose6phosphate dehydrogenase g6pd deficiency to this type of druginduced hemolytic anemia 16.

Gg diiha is rare, but there are no good data on the exact incidence and prevalence. Immune hemolytic anemia is classified as autoimmune, alloimmune, or drug induced, based on the antigen that stimulates antibody or complementmediated destruction of red blood cells. In hemolytic anemia, the red blood cell production is accelerated resulting in an increased number of reticulocytes, immature red blood cells. Druginduced hematologic disorders can affect any cell line, including white blood cells wbcs, red blood cells rbcs, and platelets. Although the majority of reported cases have been associated with chloramphenicol, many drugs have the potential to be toxic to the bone marrow. However, the true incidence is likely to be underestimated as there are a number of factors leading to misdiagnosis. Drugs are not the most common cause of hemolytic anemia. Aplastic anemia was the leading cause of death followed by thrombocytopenia, agranulocytosis, and hemolytic anemia. Immune hemolytic anemia associated with drug therapy. Antimalarial druginduced myopathy is many have an associated anemia or thrombocytopenia, an enlarged spleen, and, rarely, leg ulcers. More detailed discussions of the clinical manifestations, the drug treatment.

Drugs can induce almost the entire spectrum of hematologic disorders, affecting white cells, red cells, platelets, and the coagulation system. The dietary solution to unwanted side effects of common medications. Autoimmune hemolytic anemia autoimmune hemolytic anemia aiha is mediated by autoantibodies and further subdivided according to their maximal binding temperature. Druginduced folate deficiency the national academies. Early diagnosis and proper treatment of drug induced anemias are crucial because of the seriousness of these disorders. This deficiency is an inherited, sexlinked trait of incomplete dominance with variable expressivity 7. This deficiency is an inherited, sexlinked trait of incomplete dominance with variable expressivity 7, 8.

Numerous chemical compounds, usually drugs, have been observed to cause hemolytic anemias. Anemia classification on the basis of rbc morphology. Autoimmune hemolytic anemia aiha, druginduced hemolytic anemia, and rh disease see online here hemolytic anemia is characterized by intravascular and extravascular destruction of erythrocytes. A large number of very commonly used drugs have been reported to induce anemias. Immune hemolytic anemia is classified as autoimmune, alloimmune, or druginduced, based on the antigen that stimulates antibody or complementmediated destruction of red blood cells.

Blood dyscrasias are important toxic effects associated with the use of a wide variety of drugs. Antimalarial drugs used to treat ra eg, hydroxychloroquine and chloroquine rarely cause muscle weakness as a symptom of druginduced myopathy. Druginduced megaloblastic, aplastic, and hemolytic anemias. Many common drugs induce megaloblastic anemia by interfering with folate or vitamin b12 absorption, altering b12 metabolism, or blocking pathways in which these vitamins play a role. Recent publications have emphasized the close etiological relationship of erythrocyte glucose6phosphate dehydrogenase g6pd deficiency to this type of drug induced hemolytic anemia 16.

Despite the importance of these reactions, little is known concerning their fundamental nature. The ha can be caused by drugindependent antibodies that are indistinguishable, in vitro and in vivo, from. The most common drugs associated with diiha and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. Anemia, druginduced immune hemolytic medication list about anemia, drug induced. Drug category nutrients depleted repletion suggestions 5asa. Druginduced hemolytic anemia definition of druginduced. Drug induced anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia. Drug induced hemolytic anemia, medication causes of hemolytic anemia, drug induced immunemediated hemolysis, drug induced immune hemolytic anemia, drug induced autoimmune hemolytic anemia, drug induced thrombotic microangiopathic anemia. Early diagnosis and proper treatment of druginduced anemias are crucial because of the seriousness of these disorders. This paper aims to emphasize the broad range of drug induced hematological syndromes and to highlight some of the newer drugs and syndromes.

There are two distinct types of toxicity with differing pathogenic mechanismsa doserelated reversible marrow aplasia and a doseindependent idiosyncratic aplasia with. Diagnosis of druginduced hemolytic anemia starts like most forms of anemia, with the complete blood count cbc. General information two different mechanisms of drug induced hemolytic anemia. Druginduced immune hemolytic anemia case study antibody. Three distinct types of mechanism that render red cells sensitive to drug induced hemolysis have been delineated. Megaloblastic, aplastic and hemolytic anemias are the most common druginduced anemias. Many common drugs induce megaloblastic anemia by interfering with folate or vitamin b 12. The prognosis of patients with antithyroid drug induced aa is good overall, but may not be as favorable as that of antithyroid drug induced isolated agranulocytosis. Drug induced immune hemolytic anemia diiha is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. When a drug causes decreases in all three cell lines accompanied by a hypoplastic bone marrow, the result is drug induced aplastic anemia. Jan 29, 2020 diagnosis of drug induced hemolytic anemia starts like most forms of anemia, with the complete blood count cbc.

Drug category nutrients depleted repletion suggestions 5. Drug induced immune hemolytic anemia is considered to be rare but is likely underrecognized. When a drug causes decreases in all three cell lines accom panied by a hypoplastic bone marrow, the result is druginduced aplastic anemia. This causes red blood cells to break down earlier than normal, a process called hemolysis. In cats and dogs after eating either raw or cooked plants from the genus allium, for example, onions or garlic. Fludarabine and hemolytic anemia drug antibodies druginduced immune hemolytic anemia diiha is rare. Aplastic anemia associated with antithyroid drug treatment is rarer than antithyroid drug associated agranulocytosis. This paper aims to emphasize the broad range of druginduced hematological syndromes and to highlight some of the newer drugs and syndromes. Recently, a new mechanism of drug sensitivity has become apparent. An acquired hemolytic anemia can develop in association with drugs.

Few epidemiologic studies have evaluated the actual incidence. Feb 02, 2018 aplastic anemia occurs when the bone marrow fails and production of red blood cells, white cells, and platelets ceases i. Druginduced anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia. Druginduced immune hemolytic anemia is considered to be rare but is likely underrecognized. Review article druginduced megaloblastic, aplastic, and. When a drug causes decreases in all three cell lines accompanied by a hypoplastic bone marrow, the result is druginduced aplastic anemia. A lack of certain enzymes, which serve to maintain glutathione in the reduced form or which synthesize glutathione, renders the cell. Other drugs may also induce ane mia like ace inhibitors, phenytoin, and proton pump inhibitor. For example, heavy alcohol consumption can cause generalized. The consulting pathologist plays a critical role in integrating serologic findings with the clinical history, as druginduced antibodies should be distinguished as either drugdependent or drugindependent for appropriate clinical management.