Ahrens N, Schewior L, Garbe E, Kiesewetter H, Salama A
Institute for Transfusion Medicine, Charité- University Medicine Berlin, Germany.
Vox Sang. 2004 Jan;86(1):71-4. doi: 10.1111/j.0042-9007.2004.00389.x.
Administration of diclofenac may lead to immune haemolytic anaemia (IHA) owing to the presence of drug-dependent antibodies and/or autoantibodies. A relationship with oral or intramuscular drug administration is unknown. Here, we describe a patient who apparently tolerated oral diclofenac but developed severe IHA following intramuscular injection of the drug.
A 66-year-old-female was admitted to hospital because of jaundice and nausea, which were initially presumed to be manifestations of a postcholecystectomy syndrome. The patient soon developed haemolysis and renal failure. Although the symptoms and signs were suggestive of autoimmune haemolytic anaemia (AIHA), the patient had diclofenac-induced IHA.
Serological testing, including detection of drug-dependent antibodies, was performed using standard techniques. The patient's serum was found to contain a highly reactive diclofenac-dependent red cell antibody of the immune complex type (titre 256 000). She recovered after 7 weeks of treatment with prednisolone, blood transfusions, haemodialysis and plasma exchange.
Diclofenac-induced IHA should always be considered when a patient on diclofenac develops haemolysis.
由于存在药物依赖性抗体和/或自身抗体，双氯芬酸的使用可能导致免疫性溶血性贫血（IHA）。其与口服或肌内注射药物的关系尚不清楚。在此，我们描述一名患者，该患者显然耐受口服双氯芬酸，但在肌内注射该药后发生了严重的IHA。
一名66岁女性因黄疸和恶心入院，最初推测这些症状是胆囊切除术后综合征的表现。患者很快出现溶血和肾衰竭。尽管症状和体征提示自身免疫性溶血性贫血（AIHA），但该患者为双氯芬酸诱导的IHA。
采用标准技术进行了血清学检测，包括检测药物依赖性抗体。发现患者血清中含有一种高反应性的免疫复合物型双氯芬酸依赖性红细胞抗体（滴度为256 000）。经过7周的泼尼松龙治疗、输血、血液透析和血浆置换后，她康复了。
当服用双氯芬酸的患者发生溶血时，应始终考虑双氯芬酸诱导的IHA。
