Acute Hemolytic Anemia With Acanthocytosis Associated With High-Dose Misoprostol for Medical Abortion

Filippini, Alida; Villa, Giuliano; Corrocher, Roberto; Franceschi, Lucia De

doi:10.1016/j.annemergmed.2006.09.001

Cited by 8 publications

(2 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Drug-induced acanthocytosis is a rare phenomenon. The only reported case was with high-dose prostaglandin, which was also associated with significant haemolysis [ 9 ]. ALK tyrosine kinase activates multiple pathways associated with cell proliferation and differentiation, but the mechanism of alectinib-induced membrane changes remains unknown.…”

Section: Discussionmentioning

confidence: 99%

A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis

Gullapalli

Lewis

et al. 2021

J Hematopathol

View full text Add to dashboard Cite

Alectinib is an orally bioavailable anaplastic lymphoma kinase (ALK) inhibitor indicated for ALK mutated non-small cell lung cancer (NSCLC). This case series documents the development of significant erythrocyte membrane changes associated with alectinib use in six patients. Morphological findings found on blood film examination include moderate-marked acanthocytes, spheroacanthocytes, and one case demonstrated moderate schistocytes. Two patients in this multi-centre case series developed grade 1 anaemia, and four patients developed grade 2 anaemia. Two patients suffered significant non-immune-related haemolysis. One patient had a co-existing β thalassaemia trait and required treatment cessation due to severe haemolysis. Low-grade anaemia was seen in 22% of patients using alectinib in the ALEX trial and 5% developed ≥ grade 3 anaemia. Alterations in erythrocyte morphology and membrane structure have not been reported in the safety data and clinical trials to date. Drug-induced acanthocytosis is a rare phenomenon and has previously been reported with high-dose prostaglandin administration only. This case series highlights this important laboratory finding with alectinib use and associated clinical sequelae. Alectinib-associated acanthocytosis is likely to be more prevalent than previously recognised. We also highlight the need for vigilance in haematopathology departments for unexpected laboratory findings associated with novel therapies. These findings can be detected in the post-marketing surveillance phase and may have serious clinical implications for patients.

show abstract

Section: Discussionmentioning

confidence: 99%

A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis

Gullapalli

Lewis

et al. 2021

J Hematopathol

View full text Add to dashboard Cite

show abstract

“…In dogs and cats with severe liver disease, a striking similarity exists between the veterinary and the human syndromes of the ''spur cell'' hemolytic anemia (Christopher and Lee 1994;Shull et al 1978;Weiss, Kristensen, and Papenfuss 1993). There appears to be no linear relationship between the presence of acanthocytes and the severity of the anemia, and acanthocytes have been associated with variable degrees of hemolysis (Filippini et al 2007;Betticher and Pugin 1991;FIGURE 6.-Scanning electron micrograph of red blood cells and platelets from control rat (left) and rat administered 150 mg/kg SCH 900875 (right). An acanthocyte (arrowhead) and several platelets with irregular elongated plasma membrane projection are present.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced Hemolytic Anemia and Thrombocytopenia Associated with Alterations of Cell Membrane Lipids and Acanthocyte Formation

et al. 2010

View full text Add to dashboard Cite

CXCR3 is a chemokine receptor, upregulated upon activation of T cells and expressed on nearly 100% of T cells in sites of inflammation. SCH 900875 is a selective CXCR3 receptor antagonist. Thrombocytopenia and severe hemolytic anemia with acanthocytosis occurred in rats at doses of 75, 100, and 150 mg/kg/day. Massively enlarged spleens corresponded histologically to extramedullary hematopoiesis, macrophages, and hemosiderin pigment and sinus congestion. Phagocytosed erythrocytes and platelets were within splenic macrophages. IgG and/or IgM were not detected on erythrocyte and platelet membranes. Ex vivo increased osmotic fragility of RBCs was observed. Lipid analysis of the RBC membrane revealed modifications in phosphatidylcholine, overall cholesterol, and/or sphingomyelin. Platelets exhibited slender filiform processes on their plasma membranes, analogous to those of acanthocytes. The presence of similar morphological abnormalities in acanthocytes and platelets suggests that possibly similar alterations in the lipid composition of the plasma membrane have taken place in both cell types. This phenotype correlated with alterations in plasma lipids (hypercholesterolemia and low triglycerides) that occurred after SCH 900875 administration, although other factors cannot be excluded. The increased cell destruction was considered triggered by alterations in the lipid profile of the plasma membranes of erythrocytes and platelets, as reflected morphologically.

show abstract

Misoprostol

2016

Meyler's Side Effects of Drugs

View full text Add to dashboard Cite

Acute Hemolytic Anemia With Acanthocytosis Associated With High-Dose Misoprostol for Medical Abortion

Cited by 8 publications

References 11 publications

A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis

A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis

Drug-induced Hemolytic Anemia and Thrombocytopenia Associated with Alterations of Cell Membrane Lipids and Acanthocyte Formation

Misoprostol

Contact Info

Product

Resources

About