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Drug-induced immune hemolytic anemia
Immune hemolytic anemia secondary to drugs; Anemia - immune hemolytic - secondary to drugs
Drug-induced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the body's defense (immune) system to attack its own red blood cells. This causes red blood cells to break down earlier than normal, a process called hemolysis.
Causes
In some cases, a drug can cause the immune system to mistake your own red blood cells for foreign substances. The body responds by making antibodies to attack the body's own red blood cells. The antibodies attach to red blood cells and cause them to break down too early.
Drugs that can cause this type of hemolytic anemia include:
- Cephalosporins (a class of antibiotics), most common cause
- Dapsone
- Levodopa
- Levofloxacin
- Methyldopa
- Nitrofurantoin
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Penicillin and its derivatives
- Phenazopyridine (pyridium)
- Quinidine
A rare form of the disorder is hemolytic anemia from a lack of glucose-6 phosphate dehydrogenase (G6PD) . In this case, the breakdown of red blood cells is due to a certain type of stress in the cell.
Lack of glucose-6 phosphate dehydrogena...
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a condition in which red blood cells break down when the body is exposed to certain drugs or t...
Drug-induced hemolytic anemia is rare in children.
Symptoms
Symptoms may include any of the following:
-
Dark urine
Dark urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
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- Pale skin color
- Rapid heart rate
- Shortness of breath
-
Yellow skin color (
jaundice
)
Jaundice
Jaundice is a yellow color of the skin, mucus membranes, or eyes. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Jau...
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Exams and Tests
A physical exam may show an enlarged spleen. You may have blood and urine tests to help diagnose this condition.
Tests may include:
-
Absolute
reticulocyte count
Reticulocyte count
Reticulocytes are slightly immature red blood cells. A reticulocyte count is a blood test that measures the amount of these cells in the blood....
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Direct or indirect Coombs test
Direct or indirect Coombs test
The Coombs test looks for antibodies that may stick to your red blood cells and cause red blood cells to die too early.
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Indirect bilirubin
levels
Indirect bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
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Red blood cell count
Red blood cell count
An RBC count is a blood test that measures how many red blood cells (RBCs) you have. RBCs contain hemoglobin, which carries oxygen. How much oxygen ...
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Serum haptoglobin
Serum haptoglobin
The haptoglobin blood test measures the level of haptoglobin in your blood. Haptoglobin is a protein produced by the liver. It attaches to a certai...
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Treatment
Stopping the drug that is causing the problem may relieve or control the symptoms.
You may need to take a medicine called prednisone to suppress the immune response against the red blood cells. Special blood transfusions may be needed to treat severe symptoms.
Outlook (Prognosis)
The outcome is good for most people if they stop taking the drug that is causing the problem.
Possible Complications
Death caused by severe anemia is rare.
When to Contact a Medical Professional
See your health care provider if you have symptoms of this condition.
Prevention
Avoid the drug that caused this condition.
References
Jager U, Lechner K. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi, J, eds. Hematology: Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 44.
Michel M. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 160.
Price EA, Schrier SL. Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi, J, eds. Hematology: Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 45.
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Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
-
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
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Review Date: 2/13/2015
Reviewed By: Rita Nanda, MD, Assistant Professor of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
