Medikamentös induzierte Immunhämolysen

Die medikamentös induzierte Immunhämolyse stellt eine seltene, häufig fulminant und immer wieder letal verlaufende Sonderform der autoimmunhämolytischen Anämie dar. Sie ist wenig bekannt und wird häufig übersehen. Dieser Beitrag stellt die Besonderheiten des Krankheitsbildes inkl. wesentlicher Aspekte zur Pathogenese, Klinik, Diagnostik und Therapie vor und zeigt, welche Medikamente häufig eine Immunhämolyse auslösen können.

Abstract

Drug induced immune hemolytic anemia (DIIHA) is rare and often associated with severe hemolytic anemia and even death. It is not well known and likely under-diagnosed. DIIHA may be caused by drug-independent autoantibodies (aab) indistinguishable from idopathic warm autoantibodies causing autoimmune hemolytic anemia, or by drug-dependent antibodies (ddab). The latter only react in the presence of the drug and can cause acute and severe intravascular hemolysis. ddab usually show a positive direct antiglobulin test (DAT) and a negative eluate. However, specialized reference laboratories are often required to perform the serological tests to confirm the diagnosis. The most common drugs to cause ddab are antibiotics (mainly piperacillin and cephalosporines), non-steroidal drugs (diclofenac) and platinum-based anticancer drugs. Stopping the drug is the first and most important approach to therapy.

This paper presents the special features of the clinical picture including essential aspects of pathogenesis, clinic, diagnostics and therapy of drug induced immune hemolytic anemia.

Schlüsselwörter

medikamentös induzierte Hämolysen - medikamentenabhängige Antikörper - intravasale Hämolyse - erythrozytäre Autoantikörper

Key words

drug-induced hemolysis - drug-dependent antibodies - intravascular hemolysis - autoantibodies

Publication History

Article published online:
11 May 2023

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