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


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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Alkaline phosphatase


Alanine aminotransferase


Aspartate aminotransferase




Blood pressure


Congenital heart block




C-Reactive Protein


Disseminated intravascular coagulation


Direct and indirect


Drug induced hemolytic anemia


Drug induced immune hemolytic anemia


Ejection fraction


Erythrocyte sedimentation rate


Glucose-6-phosphate dehydrogenase


Hemolytic anemia




Heart rate


Intravenous immunoglobulin


Lactate dehydrogenase




Mean cell volume


Non-steroidal anti-inflammatory drugs


Pulmonary artery hypertension


Pulmonary artery pressure


Peripheral blood smear


Red blood cell


Respiratory rate




Total iron binding capacity


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).

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