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Drug induced hemolytic anemia
Occurs when certain drugs interact with the red blood cell membrane,
causing the cell to become antigenic.
- Alpha-Methyl dopa type: levodopa, methyldopa.
- Hapten type: Penicillins, cephalosporins.
- Quinidine type: quinidine.
- Others: mefenamic acid, salicylic acid, sulfonamides,
Thiazide diuretics, antazoline, chlorpromazine, isoniazid, streptomycin,
and Motrin. Drug-induced hemolytic anemia is most often associated with
G6PD deficiency.
Clinical suspicion
Once the diagnosis of hemolytic anemia is established drug
intake must be excluded.
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Diagnosis
Coomb test differentiates the 3 main
pathologic types.
alpha-Methyl dopa type: Coomb test is positive
for IgG.
Hapten type: The diagnosis can be established by incubating the patient's
serum with donor erythrocytes pre-incubated with penicillin. Deposition
of IgG antibody will occur only in the presence of penicillin and can
be detected with the Coombs' test.
Quinidine type: The diagnosis can be established in vitro by examining
deposition of complement (C3) on donor erythrocytes by patient serum,
which occurs only in the presence of the drug. The Coombs' test is used
to detect complement deposition on the erythrocyte surface.
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