Ahrens Norbert, Genth Ramona, Kiesewetter Holger, Salama Abdulgabar
Institute for Transfusion Medicine, Charité-University Medicine Berlin, Berlin, Germany.
Am J Hematol. 2006 Feb;81(2):128-31. doi: 10.1002/ajh.20494.
Diclofenac has been implicated in many cases of life-threatening immune hemolytic anemia (IHA). Nevertheless, confusion still occurs at the bedside and in the laboratory. Herein we report nine new patients and summarize all published cases (total, n = 61). Direct and indirect antiglobulin tests were performed according to standard procedures. Tests for drug-dependent antibodies were performed in the presence and absence of the target drugs and their ex vivo antigens (in the urine of patients treated with the drug). Diclofenac- and/or ex-vivo-antigen-dependent red cell antibodies were detected in all new cases. We identified nine new cases with diclofenac-dependent IHA. All cases were initially suspected to have an abdominal illness and/or autoimmune hemolytic anemia of warm type. Acute renal failure was present in three of the 9 new patients and in 20 of 37 published patients. Seven of the 46 patients died (15%), and clinical information is lacking in 15 other published cases. Diclofenac-dependent and/or ex-vivo-antigen-dependent IHA should always be considered when a patient on diclofenac develops acute renal failure and/or IHA.
双氯芬酸已与许多危及生命的免疫性溶血性贫血（IHA）病例相关。然而，床边和实验室仍存在混淆。在此，我们报告9例新患者，并总结所有已发表的病例（总计，n = 61）。按照标准程序进行直接和间接抗球蛋白试验。在有和没有目标药物及其体外抗原（在接受该药物治疗患者的尿液中）的情况下进行药物依赖性抗体检测。在所有新病例中均检测到双氯芬酸和/或体外抗原依赖性红细胞抗体。我们确定了9例新的双氯芬酸依赖性IHA病例。所有病例最初均怀疑患有腹部疾病和/或温抗体型自身免疫性溶血性贫血。9例新患者中有3例以及37例已发表患者中有20例出现急性肾衰竭。46例患者中有7例死亡（15%），其他15例已发表病例缺乏临床信息。当服用双氯芬酸的患者出现急性肾衰竭和/或IHA时，应始终考虑双氯芬酸依赖性和/或体外抗原依赖性IHA。
