Shirey R S, Morton S J, Lawton K B, Lowell C, Kickler T S, Ness P M
Department of Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Am J Clin Pathol. 1988 Mar;89(3):410-4. doi: 10.1093/ajcp/89.3.410.
A 70-year-old man developed severe immune intravascular hemolysis and renal failure following ingestion of fenoprofen, a nonsteroidal, anti-inflammatory drug. The patient's red blood cells were sensitized with both IgG and C3d. The serum reacted with normal red blood cells in the presence and absence of the drug. Addition of albumin to the serum inhibited the reactivity with both neat and drug-treated serum. These atypical serologic findings for drug-related immune hemolytic anemia were explained by (1) the measurement of fenoprofen by high performance liquid chromatography (HPLC) in the neat serum; and (2) solid-phase adsorption studies showing that albumin can bind drug, leading to the disappearance of agglutination when albumin is added. This case demonstrates the utility of drug levels and adsorption techniques to confirm the diagnosis of drug-induced immune hemolytic anemia despite the anomalous serologic results which obscured the diagnosis and management of the patient.
一名70岁男性在摄入非甾体抗炎药非诺洛芬后出现严重的免疫性血管内溶血和肾衰竭。患者的红细胞被IgG和C3d致敏。血清在有或无该药物的情况下均与正常红细胞发生反应。向血清中添加白蛋白可抑制其与纯血清和药物处理血清的反应性。这些与药物相关的免疫性溶血性贫血的非典型血清学发现可通过以下方式解释：（1）通过高效液相色谱法（HPLC）测定纯血清中的非诺洛芬；（2）固相吸附研究表明白蛋白可结合药物，添加白蛋白后凝集反应消失。该病例表明，尽管异常的血清学结果掩盖了患者的诊断和治疗，但药物水平检测和吸附技术对于确诊药物性免疫性溶血性贫血仍具有实用性。
