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Mild intravasal haemolysis associated with flu-syndrome during intermittent rifampicin treatment
Abstract:
Sixteen patients were given high-dose intermittent rifampicin treatment (900 mg twice weekly) in order to record side-effects of the flu-type. Three patients who experienced a febrile reaction were re-challenged under strict hospital supervision with a single dose (900 mg) of rifampicin. Two patients showed a distinct febrile response together with rapidly subsiding symptoms typical of the rifampicin-induced flu-syndrome, whereas the third patient's reaction was clinically different. During the challenge, the changes in a number of laboratory tests were indicative of a mild haemolytic reaction in the two patients with flu-syndrome. Plasma haemoglobin steeply increased within a few hours following the ingestion of the dose. This was associated with an acute increase in the total bilirubin and with a gradual decrease in the blood haemoglobin and haematocrit values. In further support of a drug-induced haemolysis was the findings that both patients showed a distinct reticulocyte response several days after the challenge. No such changes were seen in the third patient, whose reaction was later demonstrated to be related to isoniazid. The flu-syndrome thus may represent a first warning sign of intravasal haemolysis, which, if massive enough, eventually could lead to haemolytic crises and renal failure.
Insights
High-dose rifampicin can cause flu-like symptoms, which may signal dangerous intravascular hemolysis. This condition can lead to hemolytic crises and kidney failure if not managed promptly.
Area of Science:
- Pharmacology
- Clinical Medicine
- Toxicology
Background:
- High-dose intermittent rifampicin is used in treating certain infections.
- Flu-like symptoms are a known potential side effect of rifampicin therapy.
Purpose of the Study:
- To investigate the nature of flu-type side effects associated with high-dose intermittent rifampicin.
- To determine if these flu-like symptoms are indicative of underlying hemolytic reactions.
Main Methods:
- Sixteen patients received high-dose intermittent rifampicin (900 mg twice weekly).
- Three patients with febrile reactions were re-challenged with a single 900 mg dose of rifampicin under supervision.
- Laboratory tests, including plasma hemoglobin, bilirubin, hemoglobin, hematocrit, and reticulocyte counts, were monitored during re-challenge.
Main Results:
- Two of the three re-challenged patients developed flu-syndrome symptoms and showed laboratory evidence of mild intravascular hemolysis.
- Hemolysis was indicated by increased plasma hemoglobin and bilirubin, decreased hemoglobin and hematocrit, and a reticulocyte response.
- The third patient's reaction was clinically different and later attributed to isoniazid, with no signs of hemolysis.
Conclusions:
- The rifampicin-induced flu-syndrome may be an early indicator of intravascular hemolysis.
- Prompt recognition of these symptoms is crucial as severe hemolysis can lead to hemolytic crises and renal failure.