Related Experiment Videos
Methyldopa-induced hemolytic anemia in a 15 year old presenting as near-syncope
J S Naidorf1, J M Kennedy, J W Becher
1Department of Emergency Medicine, Osteopathic Medical Center of Philadelphia.
Abstract:
Methyldopa is an antihypertensive medication which is available generically and under the trade name Aldomet that is widely prescribed in the adult population and infrequently used in children. Methyldopa causes an autoimmune hemolytic anemia in a small percentage of patients who take the drug. We report a case of methyldopa-induced hemolytic anemia in a 15-year-old boy who presented to the emergency department with near-syncope. The boy had been treated with intravenous methyldopa during a trauma admission seven weeks prior to presentation. Evaluation revealed a hemoglobin of three grams, 3+ Coombs' test with polyspecific anti-human globulin and monospecific IgG reagents, and a warm reacting autoantibody. Transfusion and corticosteroid therapy resulted in a complete recovery of the patient. Emergency physicians treating children must be aware of this syndrome in order to diagnose and treat it correctly. A brief review of autoimmune and drug-induced hemolytic anemias is provided.
Insights
Methyldopa can cause autoimmune hemolytic anemia, a rare but serious condition. This case highlights the importance of recognizing this drug-induced anemia in pediatric patients presenting with symptoms like near-syncope.
Area of Science:
- Pediatric Hematology
- Clinical Toxicology
- Immunology
Background:
- Methyldopa is an antihypertensive medication prescribed for adults and rarely for children.
- Autoimmune hemolytic anemia (AIHA) is a known adverse effect of methyldopa in a small patient subset.
- Early diagnosis and management are crucial for favorable outcomes.
Observation:
- A 15-year-old male presented with near-syncope seven weeks after intravenous methyldopa treatment for trauma.
- Laboratory findings included severe anemia (hemoglobin 3 g/dL), a positive Coombs' test, and a warm autoantibody.
- The patient's presentation mimicked other causes of anemia and syncope.
Findings:
- The patient was diagnosed with methyldopa-induced autoimmune hemolytic anemia.
- Treatment with blood transfusion and corticosteroids led to complete clinical recovery.
- The positive Coombs' test and presence of a warm autoantibody confirmed the autoimmune mechanism.
Implications:
- Emergency physicians must consider methyldopa-induced AIHA in pediatric patients with unexplained anemia and relevant drug history.
- Prompt recognition and appropriate management can prevent severe complications and ensure patient recovery.
- This case underscores the need for vigilance regarding drug-induced hematologic disorders in children.