1/13. Potential drug interaction between simvastatin and danazol causing rhabdomyolysis.rhabdomyolysis is a life-threatening clinical and biochemical syndrome that results from injury to skeletal muscle. Hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) have been associated with myopathy and rhabdomyolysis. Although rhabdomyolysis is a rare adverse event associated with this class of drugs, their prevalent use in the management of dyslipidemia makes it increasingly important for clinicians to understand the nature of this condition. rhabdomyolysis can occur with all statins when used alone and particularly when combined with other drugs that are themselves myotoxic or that elevate the concentration of the statin. Statins are particularly susceptible to the latter effect because of their metabolism by the CYP450 system and their low oral bioavailability. In this report, we describe a case of rhabdomyolysis and acute renal failure secondary to the interaction between danazol and simvastatin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/13. Production of human warm-reacting red cell monoclonal autoantibodies by Epstein-Barr virus transformation.Monoclonal antibody technology has been used in both murine and human systems to produce a variety of antibodies that react with the human red cell (RBC). RBC monoclonal autoantibodies have been obtained from animal models of autoimmune hemolytic anemia (AIHA), but to date no warm-reactive monoclonal autoantibodies have been generated from human B cells. Using the Epstein-Barr virus (EBV) transformation method, clones of RBC autoantibodies were generated from two patients with AIHA. These antibodies reacted preferentially at 37 degrees C, agglutinated or bound to a variety of different RBC phenotypes, and were IgM in nature. The serologic reactivity of one clone showed a relative specificity to e RBCs that was similar to that seen in the patient's serum. These results are the first to demonstrate that warm-reactive RBC autoantibodies can be obtained from patients with AIHA using the technique of EBV transformation, and they further substantiate the existence of warm-reactive IgM RBC autoantibodies in the spectrum of warm AIHA.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/13. Idiopathic Heinz body hemolytic anemia in newborn infants.Heinz body hemolytic anemia developed in six full-term infants while at home during the first 2 weeks of life. The disorder first manifested as hyperbilirubinemia. However, in all cases, severe anemia (hemoglobin concentration 49-73 g/L) developed during the 4-12 days of hospitalization. The infants had not been exposed to known oxidants, and their erythrocytes were not glucose-6-phosphate dehydrogenase (G6PD) deficient and contained no unstable hemoglobin. It is hypothesized that in these newborn infants, Heinz body hemolytic anemia developed as a result of ingestion of an oxidant contained in feedings. The nature of this agent is as yet unknown.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/13. Evans syndrome in childhood: pathophysiology, clinical course, and treatment.Evans syndrome is defined as the simultaneous or sequential occurrence of Coombs' positive hemolytic anemia and immune thrombocytopenia without known underlying etiology. Ten cases of Evans syndrome were seen at our hospital over the past decade; three patients died. Two cases are described in detail and demonstrate the chronic, refractory nature of this condition. Most patients have required corticosteroid therapy and splenectomy, but further therapy (e.g., intravenous gammaglobulin, danazol, cyclophosphamide) is usually necessary because of recurrent autoimmune hemolytic anemia, thrombocytopenia, or both. There is a substantial risk for development of other autoimmune problems and hypogammaglobulinemia. A number of defects in humoral immunity have been described in Evans syndrome; different antibodies are directed against platelets and red blood cells. Cellular immunity is probably abnormal, but a distinct pattern of immunoregulatory disturbance has not been identified.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/13. Atypical presentation of acute phase, antibody-induced haemolytic anaemia in an infant.We describe a case of 'warm' antibody-induced haemolytic anaemia (WAIHA) in which marked depression of red cell Rh antigen expression resulted in the patient presenting with severe anaemia but a negative direct antiglobulin test (DAT). The serum contained potent IgG Rh antibodies. Unlike two previously reported cases (Koscielak, 1980; Veer et al. 1981) in which the diagnosis of WAIHA was established before the DAT became negative, this patient presented with negative serological findings during his first episode of anaemia. As a result, the serum antibodies appeared to be allo- not autoimmune in nature and to be unrelated to the patient's anaemia. Confirmation of the autoimmune nature of the Rh antibodies was not possible until nearly 2 years after the first episode of anaemia.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
6/13. The occurrence of an auto-immune hemolytic anemia with anti-U specificity in a patient with myelodysplastic syndrome.A 73-year-old man with myelodysplastic syndrome developed during the course of his illness auto-immune hemolytic anemia. The association between auto-immune hemolysis and myeloproliferative disease is extremely rare. An even more unique finding is the nature of the antibody which demonstrated single specificity against the U antigen.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/13. Immunological studies in a case of Evans' syndrome.Immunological studies in a case of Evans' syndrome (autoimmune hemolytic anemia of the "warm type" associated with idiopathic thrombocytopenic purpura) are presented in whom the autoimmune nature of both conditions was verified by the demonstration of cell-bound and free serum autoantibodies against red blood cells as well as platelets by a radioimmune technique.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/13. nature of platelet antibody in Evans syndrome: a case report.The association of autoimmune thrombocytopenia and autoimmune hemolytic anemia (Evans syndrome) has been recognized previously. Recently the present authors investigated a patient with this disorder. Both IgG and C3d were found on the patient's red cells and the serum contained a polyspecific IgG red cell antibody demonstrable only by the antiglobulin test. IgG antiplatelet antibody was demonstrated on circulating platelets as well as in the serum from the patient by using 125I-staphylococcal protein a (ISPA) assay. absorption of serum with normal platelets resulted in removal of platelet antibody, but not the red cell antibody. Furthermore, eluate prepared from platelets sensitized with patient serum contained an IgG antibody directed specifically against platelets, since it did not cross react with red cells. Our data suggest the presence of two distinct antibodies, one directed against platelets and the other against red cells in our patient with Evans syndrome. Both these antibodies are IgG in nature and belong to subclass other than IgG3 since staphylococcal protein a (SPA) binds to all subclasses of human IgG except IgG3.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/13. Reversible functional asplenia. Autoimmune hemolytic anemia with thrombocytopenia in chronic lymphocytic leukemia.An enlarged spleen failed to accumulate Tc-99m-labeled phytate, but it showed normal perfusion and uptake of labeled and heat-denatured red blood cells. A blood cell count demonstrated moderately low hemoglobin and hematocrit levels and a markedly low platelet count, and results of direct Coombs' and antiplatelet-antibody (IgG) tests were positive. Steroid therapy resulted in normal splenic function. This case demonstrates reversible functional asplenia caused by reticuloendothelial dysfunction secondary to pure splenic chronic lymphocytic leukemia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/13. sulindac-induced immune hemolytic anemia.BACKGROUND: sulindac, a nonsteroidal, anti-inflammatory, indene-derived drug, caused life-threatening immune hemolytic anemia in an individual with back pain. CASE REPORT: A patient was admitted to the hospital with immune hemolytic anemia and kidney and liver failure after several days ingestion of sulindac. The direct antiglobulin test was positive with polyspecific and monospecific anti-IgG but not with anti-C3. The eluate did not react in routine tests but reacted strongly after the addition of sulindac. The serum contained a sulindac-dependent antibody reacting to a titer of 32. The sulindac-dependent antibody was of both IgG and IgM classes and had no apparent blood group specificity. The antibody agglutinated red cells from humans and chimpanzees but not from chickens, rabbits, or sheep, which implied that a specific component on human and chimpanzee red cells was needed for reactivity. The antibody reacted with red cells treated with trypsin, papain, pronase, dithiothreitol, and sialidase. With aggressive medical care, the patient's condition improved. CONCLUSION: These findings appear compatible with the so-called immune complex mechanism for drug-induced immune hemolytic anemia. physicians are alerted to the severe nature of this syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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