scholarly journals Case Report: Oral Cimetidine Administration Causes Drug-Induced Immune Hemolytic Anemia by Eliciting the Production of Cimetidine-Dependent Antibodies and Drug-Independent Non-specific Antibodies

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuanjun Wu ◽  
Yong Wu ◽  
Yanli Ji ◽  
Yanhui Liu ◽  
Dongsheng Wu ◽  
...  

Previously, it was reported that multiple patients had hemolytic anemia associated with cimetidine administration, while only one patient who had received intravenous cimetidine was serologically diagnosed with drug-induced immune hemolytic anemia (DIIHA) caused by cimetidine-dependent antibodies. However, the ability of oral cimetidine intake to induce the production of antibodies has not been examined. In this study, we report a 44-year-old male patient in whom oral cimetidine administration resulted in cimetidine-dependent antibodies and drug-independent non-specific antibodies, leading to the development of DIIHA. Serological tests showed that the results of direct antiglobulin test (DAT) for anti-IgG (3+) and anti-C3d (1+) were positive. The IgM and IgG cimetidine-dependent antibodies (the highest total titer reached 4,096) were detected in the plasma incubated with O-type RBCs and 1 mg/mL cimetidine or the plasma incubated with cimetidine-coated RBCs. IgG-type drug-independent non-specific antibodies were detected in blood samples collected at days 13, 34, 41, and 82 post-drug intake. This is the first study to report that oral administration of cimetidine can elicit the production of cimetidine-dependent antibodies, leading to DIIHA, and the production of drug-independent non-specific antibodies, resulting in hemolytic anemia independent of cimetidine. Presence of pathogenic antibodies were detectable longer than 41 days. This suggests that patients with DIIHA caused by cimetidine need to be given necessary medical monitoring within 41 days after cimetidine intake.

2013 ◽  
Vol 69 (2) ◽  
pp. 190-192 ◽  
Author(s):  
R.S. Sarkar ◽  
J. Philip ◽  
R.S. Mallhi ◽  
Neelesh Jain

Author(s):  
Cristiane da Silva Rodrigues de Araújo ◽  
Bruna Accorsi Machado ◽  
Tamaris Fior ◽  
Júlia Mognon Mattiello ◽  
Mosseli Meinhart ◽  
...  

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Mahesh Bandara ◽  
David B. Seder ◽  
George Garratty ◽  
Regina M. Leger ◽  
Jonathan B. Zuckerman

We report a case of drug-induced immune hemolytic anemia (DIIHA) in an adult female with cystic fibrosis (CF), complicating routine treatment of a pulmonary exacerbation with intravenous piperacillin-tazobactam. Workup revealed a positive direct antiglobulin test (DAT) due to red blood cell (RBC)-bound IgG and C3 and piperacillin antibodies detectable in the patient's serum. The potential influence of CF transmembrane conductance regulator mutations on the severity of DIIHA is discussed. This report illustrates the importance of early identification of DIIHA, a rare complication of a commonly utilized medication in CF.


Hematology ◽  
2009 ◽  
Vol 2009 (1) ◽  
pp. 73-79 ◽  
Author(s):  
George Garratty

Abstract 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. The most common drugs associated with DIIHA and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. The drugs most frequently associated with DIIHA at this time are cefotetan, ceftriaxone, and piperacillin. DIIHA is attributed most commonly to drug-dependent antibodies that can only be detected in the presence of drug (eg, cephalosporin antibodies). DIIHA can also be associated with drug-independent antibodies; such antibodies do not need drug to be present to obtain in vitro reactions (eg, fludarabine). In these latter cases, the drug affects the immune system, causing production of red cell (RBC) autoantibodies; the clinical and laboratory findings are identical to autoimmune hemolytic anemia (AIHA), other than the remission associated with discontinuing the drug. Some of the mechanisms involved in DIIHA are controversial. The most acceptable one involves drugs, like penicillin, that covalently bind to proteins (eg, RBC membrane proteins); RBCs become coated with drug in vivo and, a drug antibody (usually IgG) attaches to the drug-coated RBCs that are subsequently cleared by macrophages. The most controversial is the so-called immune complex mechanism, which has been revised to suggest that most drugs are capable of binding to RBC membrane proteins, but not covalently like penicillins. The combined membrane plus drug can create an immunogen; the antibodies formed can be IgM or IgG and often activate complement, leading to acute intravascular lysis and sometimes renal failure; fatalities are more common in this group. It is still unknown why and how some drugs induce RBC autoantibodies, sometimes causing AIHA.


2020 ◽  
Vol 42 ◽  
pp. 382
Author(s):  
C.S.R. Araújo ◽  
J.M. Mattiello ◽  
L.L. Brittes ◽  
M. Meinhart ◽  
P. Bortolotti ◽  
...  

2017 ◽  
Vol 9 (04) ◽  
pp. 332-336 ◽  
Author(s):  
Preeti Rai ◽  
Geetika Sharma ◽  
Deeksha Singh ◽  
Jyoti Garg

AbstractImmune hemolytic anemia is characterized by clinical and laboratory features of hemolytic anemia with direct antiglobulin test (DAT) positivity. It could be autoimmune hemolytic anemia (AIHA), alloimmune, or drug-induced hemolysis based on the antigenic stimulus. Furthermore, based on thermal amplitude of autoantibody, AIHA is classified as warm (65%), cold (30%), and mixed (5%) type. Mixed AIHA is extremely rare in children and must be differentiated from warm AIHA with clinically insignificant cold agglutinins and cold hemagglutinin disease as their treatment is different. It may present as blood group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. Therefore, a thorough immunohematology workup including monospecific DAT, indirect antiglobulin test at 4°C and 37°C, determination of thermal amplitude and titer is essential. We hereby present two pediatric cases of mixed AIHA presenting as ABO forward and reverse blood group discrepancy and cross-match incompatibility.


AIDS ◽  
2020 ◽  
Vol 34 (2) ◽  
pp. 326-328 ◽  
Author(s):  
Kyaw S. Lin ◽  
Sein Win ◽  
Phyo P. Nyein

Transfusion ◽  
2014 ◽  
Vol 54 (11) ◽  
pp. 2901-2905 ◽  
Author(s):  
Marisol Betensky ◽  
Char Witmer ◽  
Michael J. Fisher ◽  
Sandra Nance ◽  
Mitchell J. Weiss ◽  
...  

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