Immune hemolytic anemia due to cimetidine: the first example of a cimetidine antibody.
BACKGROUND
Although there have been a few reports of immune hemolytic anemia (IHA) thought to be due to cimetidine, none of them provided proof (e.g., serologic detection of anti-cimetidine and/or repeat of IHA upon drug rechallenge). One report used cimetidine as an example of how temporal associations of drug administration and hemolytic anemia are not proof of a cause-effect relationship.


METHODS
A 63-year-old cancer patient developed IHA on two occasions after receiving cimetidine (with and without chemotherapy). Serologic methods included testing cimetidine-treated red blood cells (RBCs) as well as testing untreated RBCs in the presence of cimetidine.


RESULTS
The patient's direct antiglobulin test was positive (C3 only) and a serum antibody to cimetidine was detected by both testing methods. An eluate from the patient's RBCs was nonreactive. Cimetidine-treated RBCs were optimally prepared at room temperature and needed to be tested on the day of preparation.


CONCLUSIONS
This is the first reported case of IHA due to a cimetidine antibody where a drug-dependent antibody was demonstrated. The patient had IHA after receiving cimetidine on two separate occasions.
Arndt
Patricia A
PA
American Red Cross Blood Services, Southern California Region, Pomona, California 91768, USA. arndtp@usa.redcross.org
Garratty
George
G
Brasfield
Farah M
FM
Vemuri
Swarajyal L
SL
Asuncion
Devi J
DJ
D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001803:Blood Transfusion; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy; D002927:Cimetidine / Q000009:adverse effects* / Q000276:immunology; D003131:Combined Modality Therapy; D003298:Coombs Test; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004910:Erythrocyte Membrane / Q000187:drug effects / Q000276:immunology; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000276:immunology* / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology*; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D018448:Models, Immunological; D011241:Prednisone / Q000627:therapeutic use; D011292:Premedication
D006635:Histamine H2 Antagonists; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D002927:Cimetidine; D004155:Diphenhydramine; D011241:Prednisone