Autoimmune hemolytic anemia is a disease characterized with destruction of erythrocytes as a result of antibody produce against patient's own erythrocytes and anemia. Autoimmune hemolytic anemia can be roughly stratified into two groups according to serological features and secondary causes including drugs induced hemolytic anemia. Drugs induced autoimmune hemolytic anemia is very rare in pediatric patients. Even though hematological side effects such as leucopenia, agranulocytosis, eosinophilia, thrombocytopenic purpura and aplastic anemia might occur due to psychotropic drug use; to the best of our knowledge there is no autoimmune hemolytic anemia case due to quetiapine, an atypical antipsychotics, in literature. We hereby describe the first child case of autoimmune hemolytic anemia during quetiapine treatment.We also are pointing out that one should keep in mind serious hematological side effects with atypical antipsychotic drug use with this case report.
Agranulocytosis ; Anemia ; Anemia, Aplastic ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; Antipsychotic Agents ; Child* ; Eosinophilia ; Erythrocytes ; Humans ; Purpura, Thrombocytopenic ; Quetiapine Fumarate*

Autoimmune paraneoplastic syndromes are encountered in patients with myelodysplastic syndromes. A review of case reports suggested 10% of myelodysplastic syndrome patients may experience various autoimmune syndromes, associated with immunological-mediated hematologic abnormalities, such as Coombs' negative hemolytic anemia. In patients with myelodysplastic syndrome, Coombs' negative hemolytic anemia may be underdiagnosed due to its association with reticulocytopenia. Therefore, the findings from a peripheral blood smear and measurement of haptoglobin level are important. Autoimmune manifestations respond to immunosuppressive agents, including steroids. Herein, a case with Coombs' negative hemolytic anemia, diagnosed with myelodysplastic syndrome from a bone marrow biopsy, is reported, with a review of the previously reported literature.
Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; Biopsy ; Bone Marrow ; Haptoglobins ; Humans ; Immunosuppressive Agents ; Myelodysplastic Syndromes* ; Paraneoplastic Syndromes ; Steroids

Cephalosporins are commonly used antibiotics in treatment of clinical infection. They frequently cause a positive direct antiglobulin test, but rarely cause hemolysis. The authors report a case of immune hemolytic anemia due to a second-generation cephalosporin, cefuroxime, by the drug adsorption mechanism.
Adsorption ; Anemia, Hemolytic* ; Anti-Bacterial Agents ; Cefuroxime* ; Cephalosporins ; Coombs Test ; Hemolysis

Total hip arthroplasty was performed on a 32 year old man with hemophilia A. A series of complications were encountered; namely, femoral shaft fracture during arthroplasty, hemolytic anemia, Factor VII inhibition, pseudotumor formation and wound dehiscence and sepsis as a result of shortage of cryoprecipitate supply, and general debilitation and septicemia from fhe use of immunosuppressive agents, finally leading to death 67 days after operation. Initially, 399 bottles of cryoprecipitate (each containing approximately 100 units of Factor VII) were anticipated. In practice, however, a total of 660 bottles and packs had been consumed on the patient when the supply was exhausted. Total hip arthroplasty can be carried out on hemophilia patients, provided that the planning be impeccable and the supply of antihemophilic factor virtually unlimited.
Anemia, Hemolytic ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Factor VII ; Hemophilia A ; Humans ; Immunosuppressive Agents ; Sepsis ; Wounds and Injuries

We report a case of hemolytic uremic syndrome (HUS) associated with hemorrhagic colitis. A 35-year-old man was admitted to a local hospital because of abdominal pain and watery diarrhea that had developed about 6 hours after taking roast beef. He was treated with intravenous fluids and antibiotics, but watery diarrhea changed to bloody in nature from the next day. He was transferred to our hospital due to progressive ascites and jaundice on his 8th day of illness. Examinations revealed ascites, jaundice, microangiopathic hemolytic anemia, thrombocytopenia and uremia. Sorbitol-negative Escherichia coli was isolated from his stool, which proved as Shiga-like toxin-negative E. coli, serotype O25. His conditions improved markedly after three times of plasmapheresis and intravenous fluid therapy, and the organism was not isolated from the follow-up stool culture.
Abdominal Pain ; Adult ; Anemia, Hemolytic ; Anti-Bacterial Agents ; Ascites ; Colitis* ; Diarrhea ; Escherichia coli ; Fluid Therapy ; Follow-Up Studies ; Hemolytic-Uremic Syndrome* ; Humans ; Jaundice ; Plasmapheresis ; Thrombocytopenia ; Uremia

Autoimmune hemolytic anemia (AIHA) is a relatively common cause of anemia in children and adults with systemic lupus erythematosus (SLE). Although AIHA responds to steroids, in case of refractory or steroid-dependent AIHA, immunosuppressants and intravenous immunoglobulin have been used as second line agents. Rituximab, an anti-CD20 monoclonal antibody, is emerging in the treatment of SLE refractory to conventional therapy. Herein, we report a case of delayed and sustained remission of refractory hemolytic anemia in a child with SLE, post rituximab treatment. A 12-year-old female child with dizziness was referred to our department and was diagnosed with SLE combined with hemolytic anemia and renal tubular acidosis. Since frequent relapse of hemolytic anemia had occurred during the steroid tapering course, even though she had been treated with additional immunosuppressants (azathioprine, mycophenolate mofetil), the patient received 2 doses of rituximab 500 mg at 2 weeks interval at 18 months post diagnosis. After 15 months of rituximab administration, her anemia and renal tubular acidosis were fully recovered, enough to stop all medications. She remained well without recurrence for up to 3 years and 4 months after rituximab treatment.
Acidosis, Renal Tubular ; Adult ; Anemia ; Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Child* ; Diagnosis ; Dizziness ; Female ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Recurrence ; Steroids ; Rituximab

PURPOSE: Cyclosporine associated hemolytic uremic syndrome (HUS) is a serious complications following kidney transplantation. In this study, 2 renal transplant patients, treated by the dual drugs -Mycophenolate Mofetil (MMF) and steroid (Deflazacort), without cyclosporine- due to development of HUS, were followed-up. Additionally, IFN-gamma and IL-10 as Th1 and Th2 cytokines, respectively, and their serum levels investigated. METHODS: Following their recovery from HUS, the 2 patients have been followed for 37 and 45 months, respectively, with MMF and steroid as maintenance immunosuppressants. The serum IFN-gamma and IL-10 levels were measured simultaneously in the 2 patients on dual drug, 10 on triple drug (cyclosporine, MMF, steroid) therapies and 18 normal volunteers. The 10 patients on the triple drug therapy were selected from 14 patients, that had undergone renal transplantations in the same year as the 2 dual drug therapy patients. RESULTS: At 37 and 45 months post-transplantation, the 2 pdual drug therapy patients showed serum creatinine levels less than 1.8 and 1.7 mg/dl, respectively. The serum IFN-gamma and IL-10 levels of the 12 (2 dual and 10 triple drug therapy) renal transplant patients (11.83+/-5.01 and 5.96+/-6.02 pg/ml, respectively) were significantly higher than those of the 18 normal volunteers (7.25+/-0.84 and 1.40+/-0.81 pg/ml, respectively), (IFN-gamma: P=0.000, IL-10: P=0.000). However a comparison of IFN-gamma and IL-10 levels between the 2 dual(11.56+/-3.35 and 4.91+/-1.66 pg/ml, respectively) and 10 triple drug therapy patients (11.89+/-5.43 and 6.17+/-6.61 pg/ml, respectively) showed no significant difference (IFN-gamma: P=0.606, IL-10: P=0.485). CONCLUSION: Long-term maintenance treatment with MMF and steroid is an effective alternative therapy in case of cyclosporine induced HUS.
Creatinine ; Cyclosporine ; Cytokines ; Drug Therapy ; Healthy Volunteers ; Hemolytic-Uremic Syndrome ; Humans ; Immunosuppressive Agents ; Interleukin-10 ; Kidney Transplantation*

To study the hemolytic effect of polyphyllin II (PP II) mediated by anion channel protein and glucose transporter 1 (GLUT1), in order to initially reveal its hemolytic mechanism in vitro. In the experiment, the spectrophotometric method was adopted to detect the hemolysis of PP II in vitro and the effect of anion channel-related solution and blocker, glucose channel-related inhibitor and multi-target drugs dehydroepiandrosterone (DHEA) and diazepam on the hemolysis of PP II. The scanning electron microscope and transmission electron microscope were used to observe the effect of PP II on erythrocyte (RBC) morphology. The results showed that PP II -processed blood cells were severely deformed into spherocytes, acanthocyturia and vesicae. According to the results of the PP II hemolysis experiment in vitro, the anion hypertonic solution LiCl, NaHCO3, Na2SO4 and PBS significantly inhibited the hemolysis induced by PP II (P < 0.05), while blockers NPPB and DIDS remarkably promoted it (P < 0.01). Hyperosmotic sodium chloride, fructose and glucose at specific concentrations notably antagonized the hemolysis induced by PP II (P < 0.05). The glucose channel inhibitor Cytochalasin B and verapamil remarkably antagonized the hemolysis induced by PP II (P < 0.01). The hemolysis induced by PP II could also be antagonized by 1 gmol x L(1) diazepam and 100 μmol x L(-1) DHEA pretreated for 1 min (P < 0.01). In conclusion, the hemolytic mechanism of PP II in vitro may be related to the increase in intracellular osmotic pressure and rupture of erythrocytes by changing the anion channel transport activity, with GLUT1 as the major competitive interaction site.
Animals ; Diosgenin ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Erythrocytes ; cytology ; drug effects ; Hemolysis ; drug effects ; Hemolytic Agents ; pharmacology ; Sheep

Atypical hemolytic uremic syndrome (HUS) in adults is a life-threatening disorder characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia, which is not related to E. coli. Digital gangrene is one of the grave signs in emergency medicine because it requires prompt evaluation and treatment. We describe a 37 year-old Thailand woman, initially treated for suspected Neisseria septicemia, who went on to develop renal complications, thrombocytopenia and hemolytic anemia, which made the diagnosis of atypical hemolytic uremic syndrome. The patient was complaining of dysesthesia on all extremities and severe pain in both legs. Serologically, she was diagnosed as systemic lupus erythematosus (SLE). She was treated with plasma exchanges using fresh frozen plasma, parenteral steroid, anticoagulant and antibiotics, successfully. This is the first report of digital gangrene complicated by atypical HUS in a patient with SLE in Korea.
Acute Kidney Injury ; Adult ; Anemia, Hemolytic ; Anti-Bacterial Agents ; Emergency Medicine ; Extremities ; Female ; Gangrene ; Hemolytic-Uremic Syndrome ; Humans ; Korea ; Leg ; Lupus Erythematosus, Systemic ; Neisseria ; Paresthesia ; Plasma ; Plasma Exchange ; Sepsis ; Thailand ; Thrombocytopenia

Hemolytic uremic syndrome is characterized by a triad of clinical findings including microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The precise etiology and pathogenesis of hemolytic uremic syndrome are not established by now. According to clinical reports, hemolytic uremic syndrome is associated with infection(bacteria, virus), connective tissue disease, malignancy, drug and pregnancy. Recently, many investigators have reported that cyclosporine induces hemolytic uremic syndrome. Cyclosporine is one of the immunosuppressants that are essential for kidney transplantation. We experienced one case of hemolytic uremic syndrome that developed after kidney transplantation receiving cyclosporine. A 43-yr-old woman with end-stage renal failure received kidney transplantation from her daughter. After operation, she received cyclosporine for immunosuppression and thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure were developed. She was diagnosed as cyclosporine induced hemolytic uremic syndrome and plasma exchange was started with fresh frozen plasma. The plasma exchange was done 16 times and the clinical symptoms were improved. We present this case with review of literatures.
Acute Kidney Injury ; Anemia, Hemolytic ; Connective Tissue Diseases ; Cyclosporine* ; Female ; Hemolytic-Uremic Syndrome* ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Nuclear Family ; Plasma Exchange* ; Plasma* ; Pregnancy ; Research Personnel ; Thrombocytopenia