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Published on: March 14, 2019
Case Report: A severe drug-induced immune hemolytic anemia caused by vancomycin
Yangyi Xie1, Zhongying Wang2, Danfei Deng1
1Department of Blood Transfusion, Ningbo No.2 Hospital, Ningbo, China.
Background:
Drug-induced immune hemolytic anemia (DIIHA) is an adverse effect of some therapeutics, which is potentially life-threatening. A high priority is required in clinical treatment, since the number of medications known to induce DIIHA continues to expand. This study reports on a case of vancomycin-induced hemolysis observed in a patient in China.
Case Description:
A 50-year-old man with negative irregular antibody detection tests developed hemolytic anemia on the eighth day after replacement and repair surgery of his left knee. The patient was treated with vancomycin-mixed bone cement during the surgery, as well as vancomycin intravenously in the postoperative period every day. On the eighth day after surgery, he developed a rapid decline in hemoglobin level, elevation of indirect bilirubin and lactate dehydrogenase levels in serum, and presence of hemoglobin in urine. Laboratory analysis revealed high-titer antibodies against vancomycin in the patient's serum, which were mainly immunoglobulin G (IgG) antibodies, and demonstrated greater specificity for the blood group N antigen.
Conclusion:
This case, together with previous reports, underscores the importance of considering DIIHA in patients who exhibit unexplained decreases in hemoglobin levels following a new medication, especially antibiotics. A thorough examination of the patient's medical history and the identification of specific drug-dependent antibodies through serological tests can provide crucial insights for diagnosing DIIHA.
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