Massive haemolysis after intramuscular diclofenac in a patient who apparently tolerated oral medication.
OBJECTIVE
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.


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.
Institute for Transfusion Medicine, Charité- University Medicine Berlin, Germany. norbert.ahrens@charite.de
N
N
Ahrens
L
L
Schewior
E
E
Garbe
H
H
Kiesewetter
A
A
Salama
D000284:Administration, Oral; D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis; D000906:Antibodies / Q000097:blood; D003937:Diagnosis, Differential; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D051437:Renal Insufficiency / Q000209:etiology
D000906:Antibodies; D004008:Diclofenac