Drug-Induced Disorders

First Things First (assess & treat for the following)

• There are as many side effects from drugs we use as there are drugs.
• Hematologic effects of drugs can be mediated by one or many factors.
• The diagnosis can be difficult & may require discontinuation of an offending drug to confirm.
• Hemolysis is usually not severe, but can be in up to 2%.
• Diagnostic tests are not always specific; usually make diagnosis based on history & physical & removal of suspected drug.
• Suspect drug-induced hemolytic anemia if:
  • Anemia, fevers, rash, renal failure develop when drug started
    • Some drug-induced disorders may occur weeks to years after use.
  • Hemolytic indices are seen:
    • Anemia
    • Reticulocytosis
    • Increased LDH
    • Decreased haptoglobin
    • Increased indirect bilirubin
• Discontinue any new drug that may be responsible for a recent change in pt’s condition.
• Check
  • Coombs’ test (usually positive in autoantibody & innocent bystander types)
  • Peripheral smear for schistocytes
  • Plasma & urine for Hb
  • Blood bank screen for anti-Rh antibodies
  • For temp-induced agglutination
  • Check penicillin antibodies
  • Some drugs, like procainamide, can produce positive RF & ANAs (lupus-like). Drugs that induce lupus-like disorders do not typically have low complement or + Ds-DNA antibodies.
  • Inform blood lab about possibilities of drug-induced disease.