title: Dapsone-induced hemolytic anemia in lung allograft recipients.
abstract: BACKGROUND
  Lung transplant (LT) recipients often receive dapsone for Pneumocystis jirovecii pneumonia (PCP) prophylaxis. However, the prevalence of dapsone-induced hematologic toxicity in LT recipients is unknown. We report a high prevalence of hemolytic anemia (HA) associated with dapsone use in LT patients when compared with other patients described in the literature who have been prescribed dapsone prophylaxis.
  
  
  METHODS
  We performed a retrospective chart review on all LT recipients who received dapsone prophylaxis between 2004 and 2006. Demographics, ideal body weight (IBW), severity of anemia, transfusion requirements, laboratory evidence of hemolysis, serum creatinine and glucose-6-phosphate deyhdrogenase (G6PD) enzyme levels were collected.
  
  
  RESULTS
  Forty-three patients received dapsone. Ten (22.7%) patients had HA, despite normal G6PD levels. The mean drop in hemoglobin from baseline was 2.7 g/dl (95% confidence interval [CI] 1.9 to 3.5, p < 0.0001). Of those patients with HA, 6 had elevated serum creatinine from baseline. The odds ratio for hemolysis was 4.75 for each 1.0-mg/dl increase in creatinine (95% CI 1.07 to 21.03, p = 0.04). Mean IBW for the HA group was 58.4 kg. A dapsone dose of 100 mg/day orally resulted in a mean dose of 1.7 mg/kg.
  
  
  CONCLUSIONS
  The prevalence of dapsone-induced HA in LT recipients is 5-fold higher than the reported rate in the population of human immunodeficiency virus (HIV) patients. Individuals with renal failure or low body weight and for whom dose exceeds 1.5 mg/kg may be at increased risk for dapsone-induced HA. Although current CDC guidelines do not recommend adjusting dose by IBW or renal function, we suggest that consideration should be given to these dosing strategies.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Priyumvada M
authors.initials: PM
authors.lastname: Naik
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Allan
authors.initials: A
authors.lastname: Ramirez
authors.forename: E Clinton
authors.initials: EC
authors.lastname: Lawrence
authors.forename: David C
authors.initials: DC
authors.lastname: Neujahr
authors.forename: Seth
authors.initials: S
authors.lastname: Force
authors.forename: Andres
authors.initials: A
authors.lastname: Pelaez
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000453:epidemiology; D000890:Anti-Infective Agents / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D003622:Dapsone / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced*; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D012044:Regression Analysis; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D000890:Anti-Infective Agents; D006454:Hemoglobins; D003622:Dapsone; D003404:Creatinine; D007770:L-Lactate Dehydrogenase