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Massive haemolysis after intramuscular diclofenac in a patient who apparently tolerated oral medication
Author(s) -
Ahrens N.,
Schewior L.,
Garbe E.,
Kiesewetter H.,
Salama A.
Publication year - 2004
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/j.0042-9007.2004.00389.x
Subject(s) - haemolysis , medicine , diclofenac , intramuscular injection , anesthesia , intensive care medicine , immunology
Background and Objectives Administration of diclofenac may lead to immune haemolytic anaemia (IHA) owing to the presence of drug‐dependent antibodies and/or autoantibodies. A relationship with oral or intramuscular drug administration is unknown. Here, we describe a patient who apparently tolerated oral diclofenac but developed severe IHA following intramuscular injection of the drug. Patients and Methods A 66‐year‐old‐female was admitted to hospital because of jaundice and nausea, which were initially presumed to be manifestations of a postcholecystectomy syndrome. The patient soon developed haemolysis and renal failure. Although the symptoms and signs were suggestive of autoimmune haemolytic anaemia (AIHA), the patient had diclofenac‐induced IHA. Results Serological testing, including detection of drug‐dependent antibodies, was performed using standard techniques. The patient's serum was found to contain a highly reactive diclofenac‐dependent red cell antibody of the immune complex type (titre 256 000). She recovered after 7 weeks of treatment with prednisolone, blood transfusions, haemodialysis and plasma exchange. Conclusions Diclofenac‐induced IHA should always be considered when a patient on diclofenac develops haemolysis.