[A patient with an extremely severe immunohaemolytic anemia due to diclofenac].
A 77-year-old male was diagnosed with immunohaemolytic anaemia. He presented with fever, jaundice and oliguric renal insufficiency. He had been taking diclofenac for three days. Additional examinations and tests revealed a Coombs-positive haemolytic anaemia and thrombopenia. The micro-card gel-agglutination test demonstrated antibodies against diclofenac metabolites. After discontinuation of diclofenac and short-term treatment with prednisone and haemodialysis for two days, the patient made an almost full recovery. Haemolytic anaemia caused by diclofenac is rare. It can be caused by autoantibodies against erythrocytes and complement-fixing antibodies that bind to erythrocytes only in the presence of diclofenac or its metabolites. A timely diagnosis-supported by the appropriate laboratory tests--is of critical importance in this rare but extremely serious complication of the use of diclofenac. The treatment consists of withdrawal of diclofenac and supportive measures, possibly in combination with immunosuppressants.
Heyning
F H
FH
Afd. Algemene Interne Geneeskunde, Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden. f.h.heyning@lumc.nl
Hoogendoorn
M
M
Harvey
M S
MS
Nortier
J W
JW
D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000276:immunology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001323:Autoantibodies / Q000276:immunology*; D004008:Diclofenac / Q000009:adverse effects*; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001323:Autoantibodies; D004008:Diclofenac; D011241:Prednisone