Alectinib‐induced red cell morphological changes in a patient with underlying α‐thalassaemia trait

Li, Ting Hon Stanford; Chik, Yin Kwan Jeannie; Wong, Wai Keung

doi:10.1111/ijlh.13730

Cited by 3 publications

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“…Several reports of alectinib-induced hemolytic anemia with abnormal erythrocyte morphology have been published in recent years (Table 2) (3)(4)(5)(6). DATs were found to be negative in all of these reports, and peripheral blood smears showed abnormal erythrocyte morphology.…”

Section: Discussionmentioning

confidence: 94%

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Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect

Isomura

Tamiya

2024

Intern. Med.

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Recent studies have reported that direct antiglobulin test (DAT) results were negative in cases of alectinib-induced hemolytic anemia with abnormal red blood cell (RBC) morphology. We herein report the case of a 72-year-old female patient who was diagnosed with alectinib-induced hemolytic anemia who - in contrast to previous reports - showed a positive DAT result. After discontinuing famotidine and alectinib, the DAT results turned negative; however, when alectinib was resumed, hemolysis recurred. Although alectinib-induced hemolytic anemia has been previously thought to be associated with abnormal morphological changes of the RBCs, we suggest that alectinib-induced anemia may manifest as DAT-positive immune hemolytic anemia because of a complementary effect with other drugs.

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Section: Discussionmentioning

confidence: 94%

“…Recent studies have reported cases of alectinib-induced anemia with morphological changes of erythrocytes (3)(4)(5)(6). The direct Coombs test [also known as the direct antiglobulin test (DAT)] was negative in these studies.…”

Section: Introductionmentioning

confidence: 92%

Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect

Isomura

Tamiya

2024

Intern. Med.

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Changes in Red Cell Morphology and Haematological Laboratory Parameters Associated With Alectinib

Li,

Chik,

et al. 2024

Clinical Laboratory Analysis

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BackgroundAlectinib is a second‐generation anaplastic lymphoma kinase (ALK) inhibitor indicated for ALK‐mutated non‐small‐cell lung cancer. Recently, the association between alectinib and red cell morphological abnormalities has been reported in a few case series. This retrospective observational study aims to determine the frequency of occurrence of acanthocytosis in patients taking alectinib and to evaluate the red cell indices, biochemical markers of haemolysis and eosin‐5‐maleimide (EMA) binding assay results in patients receiving alectinib.MethodsPatients who were on alectinib and had a complete blood count test performed in Queen Elizabeth Hospital Haematology Laboratory between 1 May 2021 and 31 August 2021 were included in the study. Haematological investigations that had been performed before and after the commencement of alectinib were reviewed.ResultsFifty patients receiving alectinib were evaluated in this analysis. One hundred per cent of patients showed 3+ acanthocytes on the peripheral blood smears. Compared with the test results before starting alectinib, the post‐alectinib blood tests showed a significantly lower haemoglobin concentration, red blood cell count and haematocrit; and a significantly higher mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and red cell distribution width. All the tested patients showed a marked reduction in EMA mean channel fluorescence compared with normal control.ConclusionOur cohort revealed that alectinib caused significant acanthocytosis in all patients. Alectinib was also associated with changes in red cell indices and biochemical markers of haemolysis, compatible with a spherocytic and anisopoikilocytic morphology with haemolysis. Patients on alectinib had reduced EMA binding.

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Alectinib

2022

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Alectinib‐induced red cell morphological changes in a patient with underlying α‐thalassaemia trait

Cited by 3 publications

References 4 publications

Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect

Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect

Changes in Red Cell Morphology and Haematological Laboratory Parameters Associated With Alectinib

Alectinib

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