Salama A, Göttsche B, Mueller-Eckhardt C
Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany.
Br J Haematol. 1991 Apr;77(4):546-9. doi: 10.1111/j.1365-2141.1991.tb08624.x.
Two patients with acute immune haemolytic anaemia caused by diclofenac are described. Both patients had developed IgG drug-independent autoantibodies and drug-dependent antibodies. The drug-dependent antibodies in one patient reacted with red blood cells (RBC) only in the presence of urine from patients receiving diclofenac (ex vivo antigen) but not in the presence of the drug itself or its known metabolites. This antibody appeared to recognize a trace metabolite which has not yet been identified. The drug-dependent antibodies in the second patient reacted with RBC in the presence of urine as ex vivo antigen as well as in the presence of the drug itself and its main metabolites. Incorrect diagnosis of such cases often is due to the occurrence of autoantibodies and/or unusual drug metabolism and excretion.
本文描述了两名由双氯芬酸引起的急性免疫性溶血性贫血患者。两名患者均产生了IgG药物非依赖性自身抗体和药物依赖性抗体。其中一名患者的药物依赖性抗体仅在接受双氯芬酸治疗的患者尿液（体外抗原）存在时与红细胞（RBC）发生反应，而在药物本身或其已知代谢产物存在时则不发生反应。这种抗体似乎识别出一种尚未鉴定的微量代谢产物。第二名患者的药物依赖性抗体在尿液作为体外抗原存在时以及在药物本身及其主要代谢产物存在时均与RBC发生反应。此类病例的误诊往往是由于自身抗体的出现和/或异常的药物代谢及排泄。
