Lentzas Ioannis, Papagiannopoulos Panagiotis, Nikolaidis Ioannis, Garmiri Vasiliki, Vatides Demosthenes, Papathanasiou Athanasia, Melidonis Andreas, Tsiros Georgios, Voila Panagiota, Lionis Christos
Diabetes Center, Tzanion General Hospital, Piraeus, Tzani-Afentouli 1, 113-64 Greece.
Cases J. 2009 Jan 29;2(1):97. doi: 10.1186/1757-1626-2-97.
Idiopathic Autoimmune Hemolytic Anemia is a potentially fatal condition which requires prompt and potent treatment. Diagnosis of idiopathic autoimmune hemolytic anemia requires both serologic evidence of autoantibody presence and hemolysis. Although most of the times it is considered idiopathic, several underlying causes have been identified, like autoimmune and connective tissue diseases, viral infections, drugs or hyper function of the immune system. To our knowledge, this is the first case in the international literature describing lecithin-induced autoimmune hemolytic anemia.
This case report is to highlight a rare but dangerous adverse reaction to overdose of lecithin. A 38 year old white female from Greece, presented to our emergency room with progressive fatigue over a period of ten days and icteric discoloration of her skin and conjunctiva. The patient had been taking lecithin supplements (1200 mg, 3 capsules a day) over a period of ten days for weight loss. She reports that the last 3 days, prior to the examination, she took 5 capsules/day, so that the supplement would take effect more rapidly. Her past medical, social and family history showed no disturbance. Relatives of the patient were requested to submit any blood-tests taken over a period of 20 days prior to the onset of symptoms caused by Lecithin. All tests proved that all functions were within normal scale. Her physical examination revealed pallor and jaundice without palpable hepatosplenomegaly. Blood biochemistry tests showed total bilirubin 7.5 mg/dl, with indirect bilirubin 6.4 mg/dl and complete blood count showed hemoglobin 7.6 g/dl with blood levels 21.4%.
In every case of idiopathic autoimmune hemolytic anemia the administration of pharmaceutical substances should always be examined, except for the standard reasons that cause it. In this case the cause of hemolysis was attributed to the excessive intake of lecithin capsules for the loss of body weight. It is important that clinicians and immunologists are aware of this adverse effect.
特发性自身免疫性溶血性贫血是一种可能致命的疾病，需要及时有效的治疗。特发性自身免疫性溶血性贫血的诊断需要自身抗体存在的血清学证据和溶血证据。虽然大多数情况下被认为是特发性的，但已确定了一些潜在病因，如自身免疫性和结缔组织疾病、病毒感染、药物或免疫系统功能亢进。据我们所知，这是国际文献中首例描述卵磷脂诱导的自身免疫性溶血性贫血的病例。
本病例报告旨在强调过量摄入卵磷脂罕见但危险的不良反应。一名来自希腊的38岁白人女性因持续十天的进行性疲劳以及皮肤和结膜黄疸来到我们的急诊室。该患者在十天内一直服用卵磷脂补充剂（每天1200毫克，3粒胶囊）以减轻体重。她报告说，在检查前的最后三天，她每天服用5粒胶囊，以便补充剂能更快起效。她过去的病史、社会史和家族史均无异常。要求患者亲属提交在卵磷脂引起症状发作前20天内进行的任何血液检查。所有检查均证明所有功能均在正常范围内。她的体格检查显示面色苍白和黄疸，未触及肝脾肿大。血液生化检查显示总胆红素7.5毫克/分升，间接胆红素6.4毫克/分升，全血细胞计数显示血红蛋白7.6克/分升，血水平21.4%。
在每一例特发性自身免疫性溶血性贫血病例中，除了导致该病的标准原因外，还应始终检查药物的使用情况。在本病例中，溶血原因归因于为减轻体重而过量摄入卵磷脂胶囊。临床医生和免疫学家了解这种不良反应很重要。
