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.

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Last updated: May 20, 2010