Drug-induced immune hemolytic anemia

• Alternative Names

  Immune hemolytic anemia secondary to drugs; Anemia - immune hemolytic - secondary to drugs

• Causes, incidence, and risk factors

  In some cases, a drug can cause the immune system to mistakenly think your own red blood cells are dangerous, foreign substances. Antibodies then develop against the 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)
  • Levodopa
  • Methyldopa
  • Penicillin and its derivatives
  • Quinidine
  • Some nonsteroidal anti-inflammatory drugs (NSAIDs)

  There are many other rarer causes of drug-induced hemolytic anemia. This includes hemolytic anemia associated with glucose-6 phosphate dehydrogenase (G6PD) deficiency. But in this case, the breakdown of red blood cells is due to a certain type of stress in the cell, not the body's immune system.

  Drug-induced hemolytic anemia is rare in children.

• Symptoms
  • Dark urine
  • Fatigue
  • Pale skin color
  • Rapid heart rate
  • Shortness of breath
  • Yellow skin color (jaundice)
• Signs and tests

  A physical examination may show an enlarged spleen. A number of blood and urine tests may be done to help diagnose this condition.

  Tests may include:

  • Absolute reticulocyte count
  • Direct or indirect Coombs' test
  • Indirect bilirubin levels
  • Red blood cell count
  • Serum haptoglobin
  • Urine chemistry
• Treatment

  Stopping the drug that is causing the problem may relieve or control the symptoms.

  Some persons may be given a medicine called prednisone to reduce the immune response against the red blood cells. Special blood transfusions may be needed to treat severe symptoms.

• Expectations (prognosis)

  Most patients have a good outcome if they stop taking the drug that is causing the problem.

• Complications

  Death caused by severe anemia is rare.

• Calling your health care provider

  See your health care provider if you have symptoms of this condition.

• Prevention

  You should continue to avoid the drug that caused this condition.

• References

  Schwartz R. Autoimmune and intravascular hemolytic anemia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 164.

Review Date: 3/2/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.