Document Detail

Misdiagnosis in patients with diclofenac-induced hemolysis: new cases and a concise review.
MedLine Citation:
PMID:  16432863     Owner:  NLM     Status:  MEDLINE    
Diclofenac has been implicated in many cases of life-threatening immune hemolytic anemia (IHA). Nevertheless, confusion still occurs at the bedside and in the laboratory. Herein we report nine new patients and summarize all published cases (total, n = 61). Direct and indirect antiglobulin tests were performed according to standard procedures. Tests for drug-dependent antibodies were performed in the presence and absence of the target drugs and their ex vivo antigens (in the urine of patients treated with the drug). Diclofenac- and/or ex-vivo-antigen-dependent red cell antibodies were detected in all new cases. We identified nine new cases with diclofenac-dependent IHA. All cases were initially suspected to have an abdominal illness and/or autoimmune hemolytic anemia of warm type. Acute renal failure was present in three of the 9 new patients and in 20 of 37 published patients. Seven of the 46 patients died (15%), and clinical information is lacking in 15 other published cases. Diclofenac-dependent and/or ex-vivo-antigen-dependent IHA should always be considered when a patient on diclofenac develops acute renal failure and/or IHA.
Norbert Ahrens; Ramona Genth; Holger Kiesewetter; Abdulgabar Salama
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  81     ISSN:  0361-8609     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  128-31     Citation Subset:  IM    
Copyright Information:
2006 Wiley-Liss, Inc.
Institute for Transfusion Medicine, Charité-University Medicine Berlin, Berlin, Germany. Norbert.Ahrens@Charite.De
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MeSH Terms
Aged, 80 and over
Anemia, Hemolytic, Autoimmune / chemically induced*,  complications,  diagnosis*,  therapy
Antibodies / blood
Coombs' Test
Diagnostic Errors*
Diclofenac / adverse effects*,  immunology
Kidney Failure, Acute / chemically induced,  etiology
Middle Aged
Reg. No./Substance:
0/Antibodies; 15307-86-5/Diclofenac

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