舒林酸诱导的免疫性溶血性贫血。

Sulindac-induced immune hemolytic anemia.

作者信息

Angeles M L, Reid M E, Yacob U A, Cash K L, Fetten J V

机构信息

Immunohematology Laboratory, New York Blood Center, North Shore University Hospital at Glen Cove, New York.

出版信息

Transfusion. 1994 Mar;34(3):255-8. doi: 10.1046/j.1537-2995.1994.34394196626.x.

DOI:10.1046/j.1537-2995.1994.34394196626.x

PMID:8146901

Abstract

BACKGROUND

Sulindac, a nonsteroidal, anti-inflammatory, indene-derived drug, caused life-threatening immune hemolytic anemia in an individual with back pain.

CASE REPORT

A patient was admitted to the hospital with immune hemolytic anemia and kidney and liver failure after several days ingestion of sulindac. The direct antiglobulin test was positive with polyspecific and monospecific anti-IgG but not with anti-C3. The eluate did not react in routine tests but reacted strongly after the addition of sulindac. The serum contained a sulindac-dependent antibody reacting to a titer of 32. The sulindac-dependent antibody was of both IgG and IgM classes and had no apparent blood group specificity. The antibody agglutinated red cells from humans and chimpanzees but not from chickens, rabbits, or sheep, which implied that a specific component on human and chimpanzee red cells was needed for reactivity. The antibody reacted with red cells treated with trypsin, papain, pronase, dithiothreitol, and sialidase. With aggressive medical care, the patient's condition improved.

CONCLUSION

These findings appear compatible with the so-called immune complex mechanism for drug-induced immune hemolytic anemia. Physicians are alerted to the severe nature of this syndrome.

摘要

背景

舒林酸是一种非甾体类、抗炎的茚衍生药物，在一名背痛患者中引发了危及生命的免疫性溶血性贫血。

病例报告

一名患者在服用舒林酸几天后因免疫性溶血性贫血以及肝肾衰竭入院。直接抗球蛋白试验在多特异性和单特异性抗IgG检测中呈阳性，但抗C3检测呈阴性。洗脱液在常规检测中无反应，但加入舒林酸后反应强烈。血清中含有一种对舒林酸依赖的抗体，效价为32。该舒林酸依赖抗体属于IgG和IgM两类，且无明显血型特异性。该抗体能凝集人类和黑猩猩的红细胞，但不能凝集鸡、兔或羊的红细胞，这表明人类和黑猩猩红细胞上存在一种特定成分才能发生反应。该抗体与经胰蛋白酶、木瓜蛋白酶、链霉蛋白酶、二硫苏糖醇和唾液酸酶处理的红细胞发生反应。经过积极的医疗护理，患者病情好转。