Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
ESC Heart Fail. 2023 Apr;10(2):1449-1453. doi: 10.1002/ehf2.14299. Epub 2023 Jan 18.
Furosemide, a loop diuretic, is commonly used to treat fluid overload symptoms and heart failure. Drug-induced immune haemolytic anaemia is an unusual drug-adverse event. Furosemide-induced haemolysis is even rarer. This case report presents a 91-year-old male who developed acute haemolytic anaemia 3 days after initiating furosemide to treat myocardial infarction complicated with acute decompensated heart failure. He had increased lactate dehydrogenase and unconjugated bilirubin with undetectable haptoglobin, which indicated the destruction of red blood cells. Other causes for haemolytic anaemia, including hereditary, microangiopathic haemolytic anaemia, and paroxysmal nocturnal haemoglobinuria, were also excluded. He improved with drug cessation and a short course of glucocorticoids. This report aims to raise awareness of this rare complication caused by commonly prescribed drugs. Despite a negative result of a direct antiglobulin test, physicians must remain suspicious of drug-induced immune haemolytic anaemia in unclear cases of haemolysis.
呋塞米是一种袢利尿剂，常用于治疗液体超负荷症状和心力衰竭。药物诱导的免疫性溶血性贫血是一种不常见的药物不良反应。呋塞米诱导的溶血更为罕见。本病例报告介绍了一名 91 岁男性，在因心肌梗死并发急性失代偿性心力衰竭开始使用呋塞米治疗 3 天后出现急性溶血性贫血。他的乳酸脱氢酶和未结合胆红素升高，触珠蛋白检测不到，这表明红细胞被破坏。溶血性贫血的其他原因，包括遗传性、微血管病性溶血性贫血和阵发性睡眠性血红蛋白尿症，也被排除了。他通过停药和短期糖皮质激素治疗得到了改善。本报告旨在提高对这种由常用药物引起的罕见并发症的认识。尽管直接抗球蛋白试验结果为阴性，但在不明原因的溶血情况下，医生仍必须怀疑药物诱导的免疫性溶血性贫血。
