title: Misdiagnosis in patients with diclofenac-induced hemolysis: new cases and a concise review.
abstract: 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.
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medicine Berlin, Berlin, Germany. Norbert.Ahrens@Charite.De
authors.forename: Norbert
authors.initials: N
authors.lastname: Ahrens
authors.forename: Ramona
authors.initials: R
authors.lastname: Genth
authors.forename: Holger
authors.initials: H
authors.lastname: Kiesewetter
authors.forename: Abdulgabar
authors.initials: A
authors.lastname: Salama
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000906:Antibodies / Q000097:blood; D003298:Coombs Test; D003951:Diagnostic Errors; D004008:Diclofenac / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000906:Antibodies; D004008:Diclofenac