Die medikamentös induzierte Immunhämolyse stellt eine seltene,
häufig fulminant und immer wieder letal verlaufende Sonderform der
autoimmunhämolytischen Anämie dar. Sie ist wenig bekannt und
wird häufig übersehen. Dieser Beitrag stellt die Besonderheiten
des Krankheitsbildes inkl. wesentlicher Aspekte zur Pathogenese, Klinik,
Diagnostik und Therapie vor und zeigt, welche Medikamente häufig eine
Immunhämolyse auslösen können.
Abstract
Drug induced immune hemolytic anemia (DIIHA) is rare and often associated with
severe hemolytic anemia and even death. It is not well known and likely
under-diagnosed. DIIHA may be caused by drug-independent autoantibodies (aab)
indistinguishable from idopathic warm autoantibodies causing autoimmune
hemolytic anemia, or by drug-dependent antibodies (ddab). The latter only react
in the presence of the drug and can cause acute and severe intravascular
hemolysis. ddab usually show a positive direct antiglobulin test (DAT) and a
negative eluate. However, specialized reference laboratories are often required
to perform the serological tests to confirm the diagnosis. The most common drugs
to cause ddab are antibiotics (mainly piperacillin and cephalosporines),
non-steroidal drugs (diclofenac) and platinum-based anticancer drugs. Stopping
the drug is the first and most important approach to therapy.
This paper presents the special features of the clinical picture including
essential aspects of pathogenesis, clinic, diagnostics and therapy of drug
induced immune hemolytic anemia.
Schlüsselwörter
medikamentös induzierte Hämolysen - medikamentenabhängige Antikörper - intravasale Hämolyse - erythrozytäre Autoantikörper
Key words
drug-induced hemolysis - drug-dependent antibodies - intravascular hemolysis - autoantibodies
