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Death from drug-induced hemolytic anemia
R Taraszewski1, R Harvey, P Rosman
1Department of Internal Medicine, Western Reserve Care System-Southside Medical Center, Youngstown, OH 44501.
Abstract:
Fatal hemolytic anemia occurred in a 71-year-old man after trimethoprim-sulfamethoxazole was given for presumed cystitis. Administration of this combination has previously caused multiple hematologic reactions by affecting folic acid metabolism. Megaloblastic anemia and neutropenia have been produced by both of these agents, while sulfamethoxazole alone has induced acute hemolytic anemia in patients with hereditary deficiency of glucose-6-phosphate dehydrogenase. Although hematologic complications of trimethoprim-sulfamethoxazole treatment usually follow long-term or high-dose therapy, acute reactions apparently may occur at lower doses as well.
Insights
Trimethoprim-sulfamethoxazole can cause fatal hemolytic anemia, even at low doses. This drug combination affects folic acid metabolism, leading to severe hematologic reactions.
Area of Science:
- Pharmacology
- Hematology
- Toxicology
Background:
- Trimethoprim-sulfamethoxazole is a commonly prescribed antibiotic.
- Hematologic reactions are known adverse effects of this drug combination.
- Folic acid metabolism interference is a proposed mechanism for these reactions.
Observation:
- A 71-year-old male developed fatal hemolytic anemia after receiving trimethoprim-sulfamethoxazole for presumed cystitis.
- The patient's reaction occurred despite potentially low-dose or short-term therapy.
Findings:
- Trimethoprim-sulfamethoxazole can induce severe hematologic complications, including megaloblastic anemia, neutropenia, and acute hemolytic anemia.
- Sulfamethoxazole alone can cause acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase deficiency.
- Acute hematologic reactions may occur even with lower doses or shorter durations of therapy than typically associated with such complications.
Implications:
- Clinicians should be aware of the potential for severe, acute hematologic reactions to trimethoprim-sulfamethoxazole, irrespective of dose or duration.
- Careful patient monitoring is crucial, especially in individuals with pre-existing risk factors for hematologic disorders.
- Further research may be warranted to elucidate the precise mechanisms and identify patients at highest risk for these adverse events.