Autoimmune hemolytic anemia associated with trimethoprim–sulfamethoxazole use

Frieder, Jillian; Mouabbi, Jason; Zein, Rami; Hadid, Tarik

doi:10.2146/ajhp160203

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…Antibiotics including penicillin and cephalosporins are the drugs most often implicated in the development of AIHA (12). Autoimmune hemolytic anemia associated with other classes of antibiotics such as trimethoprim sulfamethoxazole has also been reported in few cases in literature (13,14).…”

Section: Discussionmentioning

confidence: 99%

Autosomal Recessive Polycystic Kidney Disease in a Child Complicated by Autoimmune Hemolytic Anemia: A Case Report

Kotb

Baky²,

Sayed³

et al. 2023

Pediatric Sciences Journal

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Autosomal recessive polycystic kidney disease (ARPKD) is a rare genetic disorder that presents as an isolated polycystic renal disease in childhood, or associated with congenital hepatic fibrosis and/or Caroli disease. The spectrum of complications of ARPKD include end stage kidney disease, systemic hypertension and liver disease. Anemia in ARPKD is commonly due to be reduced erythropoietin or iron deficiency. We present a 2-year old male patient with ARPKD who presented to the emergency room by striking pallor and dark urine. Initial lab work revealed Hemoglobin level 2g/dL. Blood transfusion was challenging due to difficult typing and frequent mismatch. Other labs showed elevated urea and creatinine, positive direct Coomb's anticoagulant test and positive urine culture. Imaging was consistent with ARPKD. The patient was resuscitated and after stabilization, he received pulsed methylprednisolone at 30 mg/day for 5 days followed by prednisone 2mg/kg/day for 4 weeks that was tapered over 2 months with marked improvement. Herein we report autoimmune hemolytic anemia as another and rare cause for anemia associated with ARPKD.

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Section: Discussionmentioning

confidence: 99%

Autosomal Recessive Polycystic Kidney Disease in a Child Complicated by Autoimmune Hemolytic Anemia: A Case Report

Kotb

Baky²,

Sayed³

et al. 2023

Pediatric Sciences Journal

View full text Add to dashboard Cite

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“…The most common drugs associated with AIHA in the 1970s were methyldopa and penicillin, in the beginning of the 2000s were cefotetan, ceftriaxone [11,44] and piperacillin [49]. Current data indicates as drugs inducing AIHA antibiotics (cefotetan [50,51], ceftriaxone [52][53][54][55], penicillins [56], trimethoprim-sulfamethoxazole [57]), NSAIDs (diclofenac [47]), antineoplastic/chemotherapeutic drugs [11,12,46,58], cimetidine [59], and contrast media [60]. Our patient did not receive any of the medications known to be associated with drug-associated AIHA, and transfusions of PRBC were performed when anaemia became life-threatening.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Challenges in Orthogeriatric Patients with Cold Agglutinin Haemolytic Anaemia: Case Report and Management Algorithm

2022

Ann Case Report

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Most published reports on cold agglutinin (CA) haemolytic anaemia (CAHA), a rare condition with significant perioperative management challenges, are from patients who have undergone cardiothoracic surgery with hypothermia. Here, we report a hip fracture patient with CAHA, and review the perioperative management. This is the second published case report regarding CAHA in an orthopaedic patient. An 86 year old female with a 4-year history of recurrent episodes of CAHA and multiple comorbidities (atrial fibrillation, hypertension, strokes, secondary epilepsy, vascular dementia, and type 2 diabetes mellitus complicated by diabetic retinopathy, osteoporosis, urinary incontinence, recurrent urinary tract infections, and multinodular goitre) was admitted because of a hip fracture. She was commenced on prednisolone a month prior the hip fracture. On admission, her haemoglobin was 69 g/L, lactate dehydrogenase 494 U/L, haptoglobin <0.1 g/L and the blood film showed red blood cell agglutination at room temperature, which dissociated at 37 o C. She required transfusion of 5 units of packed red blood cells during her admission. Her management included intensive temperature monitoring, use of body thermal blanket, warming intravenous and irrigation fluids and medications before administration. Surgery was performed under general anesthesia on the 4th admission day. She received unfractionated heparin for venous thromboembolism prophylaxis, antibiotics for wound infection prophylaxis, continued prednisolone, and started anti-osteoporotic medications. The patient was discharged to another hospital for rehabilitation on the 7th postoperative day. Perioperative examination and treatment of orthogeriatric patients with CAHA is challenging. The pathophysiology of CAHA is shortly revied and a management algorithm is presented.

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“…Supporting this notion, use of TMP is counter indicated in patients with folate deficiencies due to the rare possibility of anemia-related complications after high doses of TMP (and sulfamethoxazole). 59 – 61 Yet, these folate-related issues can likely be remedied simply by additional folate intake either through vitamins or dietary means.…”

Section: Discussionmentioning

confidence: 99%

A Destabilizing Domain Allows for Fast, Noninvasive, Conditional Control of Protein Abundance in the Mouse Eye – Implications for Ocular Gene Therapy

Datta

Renwick

Chau

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PurposeTemporal and reversible control of protein expression in vivo is a central goal for many gene therapies, especially for strategies involving proteins that are detrimental to physiology if constitutively expressed. Accordingly, we explored whether protein abundance in the mouse retina could be effectively controlled using a destabilizing Escherichia coli dihydrofolate reductase (DHFR) domain whose stability is dependent on the small molecule, trimethoprim (TMP).MethodsWe intravitreally injected wild-type C57BL6/J mice with an adeno-associated vector (rAAV2/2[MAX]) constitutively expressing separate fluorescent reporters: DHFR fused to yellow fluorescent protein (DHFR.YFP) and mCherry. TMP or vehicle was administered to mice via oral gavage, drinking water, or eye drops. Ocular TMP levels post treatment were quantified by LC-MS/MS. Protein abundance was measured by fundus fluorescence imaging and western blotting. Visual acuity, response to light stimulus, retinal structure, and gene expression were evaluated after long-term (3 months) TMP treatment.ResultsWithout TMP, DHFR.YFP was efficiently degraded in the retina. TMP achieved ocular concentrations of ∼13.6 μM (oral gavage), ∼331 nM (drinking water), and ∼636 nM (eye drops). Oral gavage and TMP eye drops stabilized DHFR.YFP as quickly as 6 hours, whereas continuous TMP drinking water could stabilize DHFR.YFP for ≥3 months. Stabilization was completely and repeatedly reversible following removal/addition of TMP in all regimens. Long-term TMP treatment had no impact on retina function/structure and had no effect on >99.9% of tested genes.ConclusionsThis DHFR-based conditional system is a rapid, efficient, and reversible tool to effectively control protein expression in the retina.

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Autoimmune hemolytic anemia associated with trimethoprim–sulfamethoxazole use

Abstract: A 58-year-old woman developed warm autoimmune hemolytic anemia after receiving trimethoprim-sulfamethoxazole for 5 days.

Cited by 8 publications

References 9 publications

Autosomal Recessive Polycystic Kidney Disease in a Child Complicated by Autoimmune Hemolytic Anemia: A Case Report

Autosomal Recessive Polycystic Kidney Disease in a Child Complicated by Autoimmune Hemolytic Anemia: A Case Report

Perioperative Challenges in Orthogeriatric Patients with Cold Agglutinin Haemolytic Anaemia: Case Report and Management Algorithm

A Destabilizing Domain Allows for Fast, Noninvasive, Conditional Control of Protein Abundance in the Mouse Eye – Implications for Ocular Gene Therapy

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