Martinengo Marina, Ardenghi Diego Fabio, Tripodi Gino, Reali Giorgio
Immunohematology and Transfusion Centre, Giannina Gaslini Institute, Genoa, Italy.
Transfusion. 2008 Sep;48(9):1925-9. doi: 10.1111/j.1537-2995.2008.01797.x. Epub 2008 Jun 29.
Drug-induced immune hemolytic anemia (DIIHA) is a well-known complication of drug treatment. Sensitization can occur, due to interaction of the drug and/or its metabolites with cells of the immune system, after the first drug administration, while the hemolytic crisis generally occurs after repeated administration of a drug. This event occurred in the case described here of acute hemolysis due to the administration of corticosteroids.
To define the etiopathogenesis of the hemolytic crisis, immunohematologic screening and specific tests were performed to identify antibodies against a possible drug-red cell (RBC) complex and circulating drug-anti-drug antibody immune complexes. Six drugs administered to the patient were tested and results were confirmed by test repetition using other types of corticosteroids.
Indirect antiglobulin test performed with the patient's serum sample on 22 RBC samples from commercial panels was strongly positive, while it was negative on RBCs from ABO-compatible donors. The same test repeated on commercial RBCs after washing was negative. Specific tests were negative for five of the six tested drugs, while RBCs incubated with hydrocortisone strongly reacted with the patient's serum. The same tests performed using other types of corticosteroids confirmed a reaction with the same positivity score on all tested molecules.
The positive reaction observed each time the patient's serum sample was incubated with RBCs in the presence of corticosteroids suggested that the triggering cause of hemolysis was an immune-mediated mechanism and the drug responsible for DIIHA was hydrocortisone.
药物性免疫性溶血性贫血（DIIHA）是药物治疗中一种广为人知的并发症。在首次给药后，由于药物和/或其代谢产物与免疫系统细胞相互作用，可能会发生致敏，而溶血危象通常在重复给药后出现。本文所述的急性溶血病例是由皮质类固醇给药引起的。
为了确定溶血危象的发病机制，进行了免疫血液学筛查和特异性检测，以鉴定针对可能的药物 - 红细胞（RBC）复合物的抗体以及循环药物 - 抗药物抗体免疫复合物。对患者使用的六种药物进行了检测，并通过使用其他类型的皮质类固醇重复检测来确认结果。
用患者血清样本对来自商业血库的22份RBC样本进行间接抗球蛋白试验呈强阳性，而对ABO血型相容供者的RBC呈阴性。洗涤后在商业RBC上重复相同试验呈阴性。六种受试药物中有五种特异性检测呈阴性，而与氢化可的松孵育的RBC与患者血清强烈反应。使用其他类型的皮质类固醇进行的相同试验证实，所有受试分子的反应具有相同的阳性评分。
每次患者血清样本在皮质类固醇存在下与RBC孵育时观察到的阳性反应表明，溶血的触发原因是免疫介导机制，导致DIIHA的药物是氢化可的松。
