ABSTRACT
Morerecently,Habibi(42)andSalamaandMueller-Eckhardt(81,82)presentedconvincing datathatmorethanonemechanismcanoperateinapatient.Habibi(42)describedfourpatients withdrug-inducedacutehemolyticanemiaandrenalfailure.Thepatientswereshowntohave drug-dependentantibodiestogalfenine,latamoxef,andteniposidetogetherwithdrug-dependent RBCautoantibodies.SalamaandMueller-Eckhardt(81)studied31patientswhodevelopedIHA duetonomifensine.Themajorityofthesepatients'(23cases)seracontainedlgGand/orlgA antibodiesreactingtoahighlyvariableextentwithRBCsonlyinthepresenceofthedrugand/or itsmetabolites.SeraofsixpatientscontainedonlylgGRBCautoantibodies,whichreactedin theabsenceofthedrug.Threepatientshaddrug-specificandRBCautoantibodiesintheirsera. Thepatientswithonlyautoantibodieshadalesssevereclinicalcoursethanthosewith drug-dependentantibodies,reactingbytheimmunecomplexmechanism.SalamaandMuellerEckhardt(82)alsodescribedsixpatientswhohadseverehemolyticanemiaduetocianidanol, aflavoidusedfortreatinghepatitis.Fourpatientsdevelopeddrug-dependentIgMand/orlgG antibodies.OnepatientdevelopedonlylgGRBCautoantibodies,andanotherpatientdeveloped acombinationofIgGdrug-dependentantibodiesandIgGautoantibodies.Alldrug-dependent antibodiesreactedinvitrowithRBCsinthepresenceofthedrug(i.e.,typicalofimmune complexmechanism)butunexpectedlyalsoreactedwithdrug-coatedRBCs(i.e.,typicalof drug-adsorptionmechanism).Whendrugwasaddedtothepatient'sseruminvitro(i.e.,hapten inhibitiontest),itdidnotpreventthereactionswithdrug-coatedRBCs.
