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Methotrexate-induced immune haemolytic anaemia
British Journal of Haematology
|August 1, 1983
Summary
Methotrexate (MTX) can cause acute hemolytic anemia in some patients. An IgG-3 antibody reacting with red blood cells in the presence of MTX leads to rapid destruction and phagocytosis.
Area of Science:
- Hematology
- Clinical Immunology
- Pharmacology
Background:
- Metastatic breast carcinoma treatment often involves chemotherapy.
- Chemotherapy agents like methotrexate (MTX) and 5-fluorouracil (5-FU) can have adverse effects.
- Drug-induced hemolytic anemia is a rare but serious complication.
Observation:
- A patient experienced acute hemolytic anemia after MTX and 5-FU treatment.
- Direct antiglobulin test was positive, indicating antibody-mediated red blood cell destruction.
- Specific antibody reactions were observed with MTX, not 5-FU, folic acid, folinic acid, or triamterene.
Findings:
- An IgG-3 antibody was identified, causing red blood cell agglutination specifically with MTX.
- The antibody sensitized red blood cells to macrophage phagocytosis without complement fixation.
- In vivo studies confirmed rapid destruction of MTX-treated red blood cells.
Implications:
- This study elucidates a specific mechanism of MTX-induced hemolytic anemia.
- Highlights the importance of identifying drug-specific antibodies in hemolytic reactions.
- Informs clinical practice regarding monitoring and management of chemotherapy-related hematologic toxicities.