1/3. Intravenous anti-D immune globulin-induced intravascular hemolysis in Epstein-Barr virus-related thrombocytopenia.RhoD immune globulin intravenous (anti-D IGIV) increases platelet counts in patients who have not undergone splenectomy and are positive for RhoD with idiopathic thrombocytopenic purpura. After treatment, in most patients, anemia develops as a result of immune-mediated red cell destruction in the spleen. Although intravascular hemolysis (IVH) is not expected, life-threatening IVH has been recently reported by the food and Drug Administration, and physicians are encouraged to report their experience with patients with idiopathic thrombocytopenic purpura in whom IVH develops after anti-D administration. Severe IVH was observed after treatment with anti-D IGIV in two adolescent girls with acute thrombocytopenia related to Epstein-Barr virus. They did not have hemolytic anemia before treatment. The authors believe that anti-D IGIV triggered an unusual virus-induced immune response causing hemolysis; therefore, anti-D IGIV should not be used in patients with Epstein-Barr virus-related thrombocytopenia, particularly during the acute phase of infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. cefotetan-induced hemolytic anemia after perioperative prophylaxis.Cephalosporin-induced hemolytic anemia is an acquired form of hemolytic anemia caused by interaction of drug with the immune system. Drug adsorption, drug-dependent antibody, and autoimmune induction are the three mechanisms of hemolysis. cefotetan-induced hemolytic anemia (CIHA) has been described to occur through all three mechanisms. We report four cases of CIHA that occurred after appropriate perioperative use of cefotetan. All of our patients developed an acute and severe hemolytic episode that caused significant symptoms and led to hospitalization within 1-2 weeks after exposure to cefotetan. The hemolytic process was self-limited, and all our patients responded to supportive measures and blood transfusion. This report adds to our knowledge of CIHA, a rare complication of cefotetan use. Our cases suggest that cefotetan-induced acute severe hemolysis is caused by membrane modification (nonimmunologic protein adsorption) in addition to immune complex formation. Prompt diagnosis and aggressive supportive measures are essential in minimizing morbidity and mortality from hemolysis. physicians should warn their patients about this complication. Given that hemolysis occurs when the subject is no longer under direct clinical supervision, patient awareness on how to recognize signs and symptoms of hemolysis is paramount to reducing the likelihood of this potentially lethal side effect. Finally, physicians might consider restricting cefotetan use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. A 39-year-old man with acute hemolytic crisis secondary to intravenous injection of hydrogen peroxide.The diagnosis of cancer or its recurrence is often emotionally devastating for patients and those close to them. People may have a great deal of difficulty accepting the diagnosis and may seek others' opinions about the best course of treatment. When a physician projects that there is no hope, or if a cure is no longer probable, the patient and those close to him or her may feel helpless and hopeless. Given the resultant psychologic turmoil, the patient may be led to try unproven methods. Such methods, often referred to as "cancer quackery," represent a person's attempt to reassert personal control in response to these feelings of helplessness and hopelessness. Cancer quackery involves about $2 billion each year in the united states alone. One study demonstrated that approximately 39% of the pediatric outpatients studied had either tried, considered, or received recommendations for unproven methods of cancer treatment. Laetrile and faith healing were the most frequent methods used. One of the most recent of the unproven methods of cancer treatment that have been shown to cause life-threatening complications is IV injection of hydrogen peroxide. The scientific rationale behind this procedure is still unclear, but the side effects are clearly life threatening.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |