SULINDAC-INDUCED IMMUNE HEMOLYTIC-ANEMIA

Background: Sulindac, a nonsteroidal, anti-inflammatory, indene-derive d drug, caused life-threatening immune hemolytic anemia in an individu al with back pain. Case Report: A patient was admitted to the hospital with immune hemolytic anemia and kidney and liver failure after sever al days' ingestion of sulindac. The direct antiglobulin test was posit ive with polyspecific and monospecific anti-IgG but not with anti-C3. The eluate did not react in routine tests but reacted strongly after t he addition of sulindac. The serum contained a sulindac-dependent anti body 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 n ot from chickens, rabbits, or sheep, which implied that a specific com ponent on human and chimpanzee red cells was needed for reactivity. Th e antibody reacted with red cells treated with trypsin, papain, pronas e, dithiothreitol, and sialidase. With aggressive medical care, the pa tient's condition improved. Conclusion: These findings appear compatib le with the so-called immune complex mechanism for drug-induced immune hemolytic anemia. Physicians are alerted to the severe nature of this syndrome.