Alectinib-induced Immune Hemolytic Anemia in a Patient with Lung Adenocarcinoma

Abstract

Drug-induced immune hemolytic anemia (DIIHA) is a rare condition with an increasing incidence associated with the frequent use of certain drugs. An 85-year-old woman with lung adenocarcinoma prescribed alectinib complained of dyspnea on exertion at our hospital. Based on her laboratory tests results on admission, we focused on the clinical course of anemia and hemolysis progression after alectinib administration. The patient's anemia and hemolysis gradually improved after discontinuation of alectinib, leading to a diagnosis of alectinib-induced IHA, presented here as the first case encountered in a patient with lung adenocarcinoma. Furthermore, we discuss the importance of correlating clinical laboratory findings in DIIHA.

Alectinib-Induced Severe Hemolytic Anemia in a Patient with ALK-Positive Non-Small Cell Lung Cancer: A Case Report

“…Only one case of DIHA by alectinib from Japan has been reported. 8 Previous reports have not mentioned the dose of alectinib. The dosage of alectinib overseas is double the dosage used in Japan.…”

“… 6 , 7 To our knowledge, only 7 references of DIHA caused by alectinib have been described. 8–14 In addition, there are potentially many other similar cases that have not been reported. However, no patient with grade 4 severe hemolytic anemia during treatment with alectinib has been reported previously.…”

A case of hypertensive nephropathy who died of piperacillin- tazobactam induced immune hemolytic anemia which aggravated renal dysfunction: complete follow-up of serology and disease course

“…In China, DIIHA has not yet been included in the medication risk monitoring system. It is now clear that there are nearly 140 drugs that can cause DIIHA through immune complex mechanisms (ie, drug-induced antibodies) [5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]38] , but DIIHA has not been included in the list of side effects of these drugs, and there is a lack of DIIHA vigilance, the vast majority of DIIHA may be missed, misdiagnosed, delayed in diagnosis, or given improper intervention, which increases the risk of patients' administration. Incorporating DIIHA into the medication risk monitoring system and improving the awareness and vigilance of DIIHA will help avoid the serious consequences of DIIHA on patients.…”

“…The NIPA mechanism can only cause a positive result of the direct antiglobulin test (DAT) and slow, di cult to observe slight hemolysis [6][7][8] . It has been reported that nearly 140 kinds of drugs can cause DIIHA through drug-induced antibodies, and there are 10 kinds of drugs with NIPA effect [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

“…The NIPA mechanism can only cause a positive result of the direct antiglobulin test (DAT) and slow, di cult to observe slight hemolysis [6][7][8] . It has been reported that nearly 140 kinds of drugs can cause DIIHA through drug-induced antibodies, and there are 10 kinds of drugs with NIPA effect [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .Piperacillin is a semi-synthetic penicillin against pseudomonas, which belongs to the β-lactam broad-spectrum antibiotics and exerts bactericidal activity by inhibiting the synthesis of sensitive bacterial cell walls. Because some pathogenic bacteria can produce β-lactamase and are resistant to β-lactam antibiotics.…”