Bosentan-induced immune hemolytic anemia in 17 years old man. A case report

Abstract

Hemolytic anemia is a very important immune-mediated reaction, which its late diagnosis can be fatal. Medications along with other causes can induce hemolytic anemia. Drug induced immune hemolytic anemia (DIIHA) is caused by the development of autoantibodies. Accordingly, DIIHA is rare and there is not enough data for its prevalence. Number of drugs that can cause DIIHA have increased in recent decades. A 17-year-old man who had congenital single ventricle heart (CHB) and pulmonary artery hypertension (PAH) was admitted at Imam Khomeini hospital complex affiliated to Tehran University of Medical Sciences, with chief complaint of jaundice and icter. Bosentan and Tadalafil were in the list of the drugs used by this patient. Although both drugs were recommended to be discontinued in the patient, in the course of hospitalization, the patient accidentally continued to take his Tadalafil. However, the patient’s recovery continued. Given that the patient’s Coombs test was positive, his hemolytic anemia mechanism was drug-induced immune-mediated hemolytic anemia. As a result, according to Naranjo score = 6, Bosentan was considered as the main possible culprit to induce DIIHA in this patient. Following the discontinuation of Bosentan and receiving Prednisolone, the patient’s clinical symptoms and laboratory parameters resolved and the patient was then discharged.

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Abbreviations

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BIL:

Bilirubin

BP:

Blood pressure

CHB:

Congenital heart block

Cr:

Creatinine

CRP:

C-Reactive Protein

DIC:

Disseminated intravascular coagulation

D/ID:

Direct and indirect

DIHA:

Drug induced hemolytic anemia

DIIHA:

Drug induced immune hemolytic anemia

EF:

Ejection fraction

ESR:

Erythrocyte sedimentation rate

G6PD:

Glucose-6-phosphate dehydrogenase

HA:

Hemolytic anemia

Hgb:

Hemoglobin

HR:

Heart rate

IVIG:

Intravenous immunoglobulin

LDH:

Lactate dehydrogenase

Mg:

Milligram

MCV:

Mean cell volume

NSAIDs:

Non-steroidal anti-inflammatory drugs

PAH:

Pulmonary artery hypertension

PAP:

Pulmonary artery pressure

PBS:

Peripheral blood smear

RBC:

Red blood cell

RR:

Respiratory rate

SC:

Sub-cutaneous

TIBC:

Total iron binding capacity

WBC:

White blood cell count

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Correspondence to Soha Namazi.

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Afra, F., Mehri, M. & Namazi, S. Bosentan-induced immune hemolytic anemia in 17 years old man. A case report. DARU J Pharm Sci (2021). https://doi.org/10.1007/s40199-020-00386-1

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Keywords

  • Drug-induced immune hemolytic anemia (DIIHA)
  • Pulmonary artery hypertension (PAH)
  • Bosentan
  • Hemolytic anemia
  • Congenital heart block (CHB)