Yingchoncharoen Pitchaporn, Thongpiya Jerapas, Maharjan Shrinkhala, Abdelnabi Mahmoud, Kim Samuel, Saowapa Sakditad, Lalmuanpuii Judy
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Nepalgunj Medical College, Kohalpur, Banke, Nepal.
Eur J Case Rep Intern Med. 2023 Jan 27;10(2). doi: 10.12890/2023_003740. eCollection 2023.
Drug-induced immune haemolytic anaemia (DIIHA) is a rare but serious complication affecting approximately 1 in 1,000,000 patients, but its incidence might be underestimated due to misdiagnosis. Several factors should be considered to ensure an accurate diagnosis, including previous medical history, comorbidities, drug history, the temporal relationship between drug exposure and symptom onset, haemolytic features, and comorbidities in suspected cases. The authors report a case of DIIHA caused by combination chemotherapy with carboplatin and paclitaxel complicated with haeme pigment-induced acute kidney injury.
Drug-induced immune haemolytic anaemia (DIIHA) should be suspected in patients with abrupt immune haemolytic anaemia with a temporal relationship between drug exposure and symptom onset.The main management of DIIHA consists of urgent discontinuation of the suspected drug and supportive treatment with close monitoring, resulting in a favourable outcome in most cases; the role of corticosteroids in DIIHA remains unclear.Haeme pigment-induced acute kidney injury is induced by intravascular haemolysis where urinalysis reveals elevated haemoglobin.
药物性免疫性溶血性贫血（DIIHA）是一种罕见但严重的并发症，影响约百万分之一的患者，但其发病率可能因误诊而被低估。为确保准确诊断，应考虑几个因素，包括既往病史、合并症、用药史、药物暴露与症状发作之间的时间关系、溶血特征以及疑似病例中的合并症。作者报告了1例由卡铂和紫杉醇联合化疗引起的DIIHA病例，该病例并发血红素色素诱导的急性肾损伤。
对于出现急性免疫性溶血性贫血且药物暴露与症状发作之间存在时间关系的患者，应怀疑药物性免疫性溶血性贫血（DIIHA）。DIIHA的主要治疗措施包括紧急停用可疑药物并密切监测下进行支持治疗，多数情况下可取得良好疗效；皮质类固醇在DIIHA中的作用仍不明确。血红素色素诱导的急性肾损伤由血管内溶血引起，尿液分析显示血红蛋白升高。
