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Drug-Induced Hemolytic Anemia

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Drug-Induced Hemolytic Anemia, Medication Causes of Hemolytic Anemia, Drug Induced Immune-Mediated Hemolysis, Drug-Induced Immune Hemolytic Anemia, Drug-Induced Autoimmune Hemolytic Anemia, Drug-Induced Thrombotic Microangiopathic Anemia

  • Mechanisms
  1. Drug-absorption or hapten-induced
    1. Medication coats Red Blood Cell surface
    2. Induces IgG Antibody production
  2. Immune-complex
    1. Drug stimulates IgM production and binding
    2. Drug-IgM complex binds RBC and complement induced
  3. Autoantibody
    1. Drug stimulates IgG production against RBC membrane
  • Causes
  • By Mechanism
  1. Immune Hemolytic Anemia
    1. Beta-lactamase Inhibitors (e.g. Sulbactam, Clavulanic Acid, Tazobactam)
    2. Cefotetan (common)
    3. Ceftriaxone (common)
    4. Fludarabine
    5. Intravenous Immunoglobulin (IV Ig)
    6. Methyldopa (common in past)
    7. NSAIDs (common)
    8. Penicillin (common in past)
    9. Piperacillin with Tazobactam or Zosyn (common)
  2. Thrombotic Microangiopathic Anemia (only 5% of MAHA Cases)
    1. Bupropion (Wellbutrin)
    2. Chemotherapy
    3. Clopidogrel (Plavix)
    4. Cocaine
    5. Cyclosporine (common cause)
    6. Ibuprofen
    7. Interferon
    8. Mefloquine
    9. Methylenedioxymethamphetamine (MDMA, Ecstacy)
    10. Metronidazole (Flagyl)
    11. Nitrofurantoin (Macrobid)
    12. Quetiapine (Seroquel)
    13. Quinine (common cause)
    14. Simvastatin (Zocor)
    15. Tacrolimus (Prograf, common cause)
    16. Trimethoprim Sulfamethoxazole (Bactrim, Septra)
  3. Oxidation Hemolysis
    1. Dapsone
    2. Nitrofurantoin
    3. Nitrous Oxide Abuse
    4. Phenazopyridine
    5. Primaquine
    6. Ribavirin
    7. Rifampin
  • Causes
  • Extravascular (IgG) vs Intravascular Hemolysis (C3)
  1. Positive Anti-IgG (Extravascular Hemolysis)
    1. Alpha-Methyldopa
    2. Ampicillin
    3. Carbenicillin
    4. Diclofenac
    5. Ibuprofen
    6. Interferon alfa
    7. Levodopa
    8. Mefenamic acid
    9. Methicillin
    10. Penicillin
    11. Procainamide
  2. Positive Anti-C3 (Intravascular Hemolysis)
    1. Acetaminophen
    2. Chlorpromazine
    3. Fluorouracil
    4. Hydrochlorothiazide
    5. Hydralazine
    6. Insulin
    7. Isoniazid
    8. Melphalan
    9. Phenacetin
    10. Probenacid
    11. Quinidine
    12. Quinine
    13. Rifampin
    14. Streptomycin
    15. Sulfonamides
    16. Sulindac
    17. Tetracycline