ABSTRACT
ABSTRACT Background. The prevalence of two functional polymorphisms (rs1127354 and rs7270101) of the inosine triphosphatase (ITPA) gene associated with ribavirin-induced hemolytic anemia (RIHA) during antiviral therapy for hepatitis C virus (HCV) infection varies by ethnicity. In Mexico, the distribution of these polymorphisms among Native Amerindians (NA) and admixed population (Mestizos) is unknown. This study aimed to determine the prevalence of the ITPA polymorphisms among healthy NA and Mestizos, as well as in HCV patients from West Mexico. Material and methods. In a cross-sectional study, 600 unrelated subjects (322 Mestizos, 100 NA, and 178 treatment-naïve, HCV-infected Mestizos patients) were enrolled. A medical history was registered. ITPA genotype was determined by Real-Time PCR. Fst-values and genetic relatedness between study and reference populations were assessed. Results. The frequency of the risk genotypes rs1127354CC and rs7270101AA was higher among NA (98-100%) than in Mestizos (87-92.9%), (p < 0.05). The NA presented the highest prevalence of the rs1127354CC genotype reported worldwide. The Fst-values revealed a genetic relatedness among Mexican NA, South Americans and African populations (p > 0.05). The frequency of the predicted risk for RIHA was higher among NA (98%) than in Mestizos (80.5%) and HCV-infected patients (81.5%) (p < 0 .01). The CC/AA alleles were associated with lower values of total bilirubin, aspartate/alanine aminotransferases, and aspartate-to-platelet-ratio-index score among HCV-patients. Conclusion. A high prevalence of the ITPA polymorphisms associated with RIHA was found in Mexican NA. These polymorphisms could be a useful tool for evaluating potential adverse effects and the risk or benefit of antiviral therapy in Mexicans and other admixed populations.
Subject(s)
Humans , Middle Aged , Antiviral Agents/adverse effects , Pyrophosphatases/genetics , Ribavirin/adverse effects , Polymorphism, Single Nucleotide , Pharmacogenomic Variants , Anemia, Hemolytic/genetics , Anemia, Hemolytic/chemically induced , Phenotype , Indians, North American/genetics , Case-Control Studies , Prevalence , Risk Factors , Genetic Predisposition to Disease , Genetic Association Studies , Real-Time Polymerase Chain Reaction , Gene Frequency , Anemia, Hemolytic/diagnosis , Anemia, Hemolytic/ethnology , Mexico/epidemiologyABSTRACT
To report a rare side effect of metformin, an oral antidiabetic drug that is used for the treatment of type 2 diabetes mellitus. Clinical Presentation and Intervention: A 17-year-old boy was hospitalized for receiving acute lymphoblastic leukemia treatment that was composed of vincristine, L-asparaginase, daunorubicin, and prednisone. Hyperglycemia was determined without any clinical sign and metformin was started for steroid-induced insulin resistance. On the second day of metformin treatment, the patient's hemoglobin level decreased, and a direct Coombs test was positive for immunoglobulin G but negative for complement. An indirect Coombs test was negative. The glucose-6-phosphate dehydrogenase level was within the normal range. Drug-induced hemolytic anemia was suspected and metformin was discontinued. The jaundice gradually disappeared and there was no requirement for red blood cell transfusions. This case showed that physicians should be aware of the potential side effect of metformin although it is infrequent
Subject(s)
Humans , Male , Anemia, Hemolytic/chemically induced , Diabetes Mellitus, Type 2ABSTRACT
While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.
Subject(s)
Humans , Male , Middle Aged , Anemia, Hemolytic/chemically induced , Anti-Bacterial Agents/therapeutic use , Antimalarials/therapeutic use , Artemisinins/adverse effects , Atovaquone/therapeutic use , Azithromycin/therapeutic use , Babesiosis/complications , Benin , Blood/parasitology , Coinfection/diagnosis , Drug Combinations , France , Korea , Malaria, Falciparum/complications , Plasmodium falciparum/isolation & purification , Proguanil/therapeutic use , Travel , Treatment OutcomeABSTRACT
JUSTIFICATIVA E OBJETIVOS: As cefalosporinas de segunda e terceira geração têm sido descritas como a causa mais comum de anemia hemolítica (HA) induzida por fármacos. A AH causada por ceftriaxona apesar de ser um evento raro, vem sendo descrita tanto em crianças quanto em adultos sendo estes a maioria idosa, acima de 60 anos. A apresentação clínica da AH induzida pelo ceftriaxona é usualmente abrupta com palidez, taquipneia,parada cardiorrespiratória e choque. O objetivo deste estudo foi relatar um caso de AH autoimune associada ao ceftriaxona com evolução fatal e breve revisão da literatura. RELATO DO CASO: Paciente do sexo feminino, 55 anos, com diagnóstico de infecção urinária apresentou AH autoimune intravascular com hemoglobina de 4,5 g/dL, após infusão de ceftriaxona não sobrevivendo ao evento apesar de todo o suporte intensivo. CONCLUSÃO: O ceftriaxona é um fármaco comumente usado e pode causar AH fatal; o reconhecimento precoce da AH e a instituição de suporte intensivo são fundamentais para a tentativa de um prognóstico mais favorável.
BACKGROUND AND OBJECTIVES: The second and third generation cephalosporins have been reported as the most common cause of drug-induced hemolytic anemia (HA). The ceftriaxone-induced HA despite being a rare event, has been described both in children and adults and these mostly elderly above 60 years. The clinical presentation of ceftriaxone-induced HA isusually abrupt with pallor, tachypnea, cardio-respiratory arrestand shock. We report here a ceftriaxone-induced HA case withfatal outcome and a concise review of the literature. CASE REPORT: Female patient, 55 years, with urinary infection had HA autoimmune intravascular resulting in hemoglobinof 4.5 g/dL, after ceftriaxone infusion, not surviving the event despite all the intensive care. CONCLUSION: Ceftriaxone is a drug commonly used and can cause fatal HA; early recognition of HA and the institution of intensive support are essential for attempting a more favorable prognosis.
Subject(s)
Humans , Female , Middle Aged , Autoimmunity , Anemia, Hemolytic/complications , Anemia, Hemolytic/chemically induced , Ceftriaxone/adverse effectsSubject(s)
Adolescent , Aluminum Compounds/poisoning , Anemia, Hemolytic/chemically induced , Anemia, Hemolytic/therapy , Disseminated Intravascular Coagulation/chemically induced , Disseminated Intravascular Coagulation/therapy , Erythrocyte Transfusion , Female , Humans , Pesticides/poisoning , Phosphines/poisoning , Suicide, AttemptedABSTRACT
Multidrug therapy (WHO/MDT) in multibacillary leprosy consists of treatment with rifampicin, dapsone andclofazimine. However, adverse effects can cause the patient to abandon treatment. We report on a patient whopresented agranulocytosis and hemolytic anemia associated with this treatment regime. We also examined theimportance of laboratory exams for diagnosis and follow-up of the patient, and for early detection of adverse effects, with a view to improving adhesion to treatment and contributing to the eradication of Hansens disease as a public health issue.
Subject(s)
Adult , Female , Humans , Agranulocytosis/chemically induced , Anemia, Hemolytic/chemically induced , Leprostatic Agents/adverse effects , Clofazimine/adverse effects , Dapsone/adverse effects , Drug Therapy, Combination/adverse effects , Leprosy/drug therapy , Rifampin/adverse effectsABSTRACT
Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
Subject(s)
Female , Humans , Middle Aged , Anemia, Hemolytic/chemically induced , Anti-Bacterial Agents/adverse effects , Cefoperazone/adverse effects , Ceftizoxime/adverse effects , Erythrocytes/chemistry , Sulbactam/adverse effectsABSTRACT
Wilson disease is a hereditary disorder of copper metabolism which can present with hepatic, neurologic or psychiatric symptoms and in rare cases as a hemolytic disturbance. Free copper can result in red blood cell damage and hemolysis which is a rare feature of the disease affecting less than 10% of patients. In this condition the liver is usually involved and liver transplantation can be life saving. This article is a case report of acute hemolytic crisis as the initial manifestation of Wilson disease. An 8 years old girl was admitted in pediatric ward of Golestan hospital because of abdominal pain, icterus, anemia and tea color urine. Hepatitis or Glucose 6 Phosphate Dehydrogenase deficiency was the first diagnosis. Because of unresponsiveness to transfusion, Wilson disease was considered and the diagnosis was established with the presence of Kayser Fleischer ring. Chronic or acute hemolytic anemia is a rare or unusually presentation of Wilson disease. In any child especially older than 5 years with liver disease or hemolytic anemia, Wilson disease should be considered and appropriate diagnostic tests performed
Subject(s)
Humans , Female , Anemia, Hemolytic/chemically induced , Copper/blood , Diagnosis, Differential , Glucosephosphate Dehydrogenase Deficiency , Hepatitis/etiology , Acute Disease , Hepatolenticular Degeneration/diagnosis , Jaundice , Abdominal PainABSTRACT
Treatment of chronic hepatitis C consists of inteferon plus ribavirin. The major adverse effect of ribavirin is hemolytic anemia, a complication that limits therapy. Folic acid supplementation is used to improve erythropoiesis in chronic hemolytic anemia. The aim of this study was to evaluate the effectiveness of folic acid supplementation in the prevention of ribavirin-induced anemia in patients being treated for hepatitis C. Twenty one patients enrolled in treatment protocols for hepatitis C received folic acid 1 mg daily and 22 did not. Groups were similar in age, gender, ribavirin dose and baseline hemoglobin. Folic acid supplementation had no effect in the decrease in hemoglobin or the measured parameters of hemolysis. No difference between males and females was noted for hemoglobin decrease or lowest hemoglobin levels. In our study, folic acid showed no beneficial effect in the prevention of ribavirin-induced anemia.
Subject(s)
Humans , Male , Female , Middle Aged , Folic Acid/therapeutic use , Anemia, Hemolytic/prevention & control , Antiviral Agents/adverse effects , Ribavirin/adverse effects , Anemia, Hemolytic/blood , Anemia, Hemolytic/chemically induced , Haptoglobins/analysis , Hemoglobins/analysis , Hepatitis C/drug therapy , Interferons/therapeutic useABSTRACT
Se pretendió considerar la relación existente entre el papel que desempeña la G6PD y el estrés oxidativo, además, exponer los posibles mecanismos que ocasionan la hemólisis. La glucosa 6 fosfato deshidrogenasa es una de las enzimas críticas para el funcionamiento y la supervivencia de los glóbulos rojos. Al analizar la función de esta enzima en el eritrocito se comprende su estrecha vinculación con los procesos relacionados con el estrés oxidativo, en los individuos que son portadores de formas enzimáticas con actividad disminuida. Los pacientes portadores de esta deficiencia enzimática son susceptibles a la acción de los agentes oxidantes, esto hace que la mayoría de los casos presenten una anemia hemolítica de intensidad variable desencadenada por la ingestión de ciertas drogas, habas limas o en el transcurso de procesos infecciosos severos. Otra forma de presentación es la ictericia neonatal
Subject(s)
Humans , Anemia, Hemolytic/etiology , Anemia, Hemolytic/chemically induced , Glucosephosphate Dehydrogenase Deficiency , Hemolysis , Oxidative StressABSTRACT
Primaquine (8-aminoquinoline), the only effective drug to prevent relapses of the persistent liver forms of Plasmodium vivax and Plasmodium ovale, can induce hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The severity varies considerably among affected individuals. Three hundred and sixty-four Plasmodium vivax cases (342 G6PD-normal and 22 G6PD-deficient) were given a 3-day course of chloroquine (total dose 1,500 mg) followed by primaquine 15 mg a day for 14 days and completed a 28-day follow-up. All G6PD-deficient patients were male; there were no relapses or serious adverse events during the study. Although a significant decrease in hematocrit levels and an increase in the percent reduction of hematocrit levels were observed on day 7 (34.9+/-5.0 vs 26.7+/-5.4; (-1.2)+/-14.4 vs (-24.5) +/-13.9 respectively) and on day 14 (35.7+/-4.3 vs 30.9+/-3.1; 1.6+/-17.8 vs (-11.0) +/-19.3 respectively) blood transfusion was not required. Daily doses of 15 mg of primaquine for 14 days following a full course of chloroquine when prescribed to Thai G6PD deficient patients where Mahidol variant is predominant, are relatively safe.
Subject(s)
Adult , Anemia, Hemolytic/chemically induced , Antimalarials/administration & dosage , Chloroquine/administration & dosage , Female , Glucosephosphate Dehydrogenase/metabolism , Hematocrit , Humans , Malaria, Vivax/blood , Male , Primaquine/administration & dosage , ThailandSubject(s)
Humans , Paraproteinemias/chemically induced , Hematopoietic System , Agranulocytosis/chemically induced , Anemia, Aplastic/chemically induced , Anemia, Hemolytic/chemically induced , Hematopoiesis/physiology , Neutropenia/chemically induced , Paraproteinemias/classification , Hematopoietic System/physiology , Thrombocytopenia/chemically inducedABSTRACT
Penicillin-induced immune haemolytic anaemia is very rare. A ten year-old-female with rheumatic mitral stenosis on benzathine penicillin prophylaxis presented with features of haemolytic anaemia and investigations supported the diagnosis of immune haemolytic anaemia. Patient responded to discontinuation of the drug and therapy with oral prednisolone. This is first such case reported from India.
Subject(s)
Anemia, Hemolytic/chemically induced , Child , Female , Humans , Penicillin G Benzathine/adverse effects , Penicillins/adverse effectsABSTRACT
Ditaxis desertorum Pax et K. Hoffm., planta herbácea da família Euphorbiaceae, causou experimentalmente em bovinos um quadro caracterizado por hemoglobinúria em virtude de sua ação hemolítica, quando administrada por via oral em doses diárias de 1,0 a 2,5 g/kg (planta fresca), a partir do 4° ao 8° dia do experimento. Após um período de 3 a 5 dias em que os animais tiveram hemoglobinúria e anemia acentuadas, apesar de continuarem a receber a planta (durante um total de 12 a 14 dias), em três dos quatro animais esses sintomas desapareceram. Verificou-se nesses casos uma rápida recuperação dos valores hemáticos logo que cessou a hemoglobinúria. O quarto bovino, que recebeu 2,5 g/kg/dia durante 5 dias, morreu no 8° dia, tendo apresentado durante os últimos 4 dias de vida hemoglobinúria e anemia acentuadas. À necropsia e nos exames histopatológicos deste animal foram verificadas nefrose hemoglobinúrica e distrofia hepática com necrose centrolobular do parênquima. Dose de 7,7 g/kg única ou quantidades de 2,5 e 3 g/kg/dia administradas durante 2 dias seguidos, causaram em três outros bovinos quadro clínico de cólica, com morte em questão de horas, verificando-se à necropsia acentuado edema da parede do rúmen e do retículo. Pelos históricos obtidos somente ocorre, sob condições naturais, a intoxicação caracterizada pelo quadro da anemia hemolítica, indicando que possivelmente a ingestão de D. desertorum em quantidades necessárias para causar o quadro com lesões dos proventrículos ser, apesar de sua boa palatabilidade, autolimitada pelo efeito cáustico da planta