allopurinol and Anemia--Aplastic

Topics: Allopurinol; Anemia, Aplastic; Azathioprine; Bile Duct Diseases; Erythrocyte Transfusion; Gout Suppressants; Humans; Immunosuppressive Agents; Male; Middle Aged

Aplastic anemia is a rare complication of allopurinol use. We report an unusual case of aplastic anemia associated with allopurinol therapy for hyperuricemia in a patient with chronic kidney disease. A 37-year-old female patient diagnosed with Stage III chronic kidney disease was admitted with pancytopenia. She had a history of taking allopurinol for 5 months. Her bone marrow showed extremely decreased cellularity (< 20%) and there was no malignant cell infiltration. She was free of infections, including parvovirus B19, cytomegalovirus and Epstein-Barr virus. These results suggested a diagnosis of aplastic anemia. Allopurinol was discontinued immediately and treatment with blood transfusions and prednisolone was begun. After 6 months, the bone marrow cellularity improved to approximately 70%. Recently, it was suggested that decreased activity of multidrug resistance P-glycoprotein may play a role in acquired aplastic anemia. So we measured the inhibitory effect of allopurinol and oxypurinol on P-glycoprotein activity. But neither allopurinol nor oxypurinol inhibited P-glycoprotein activity.

Topics: Adult; Allopurinol; Anemia, Aplastic; Enzyme Inhibitors; Female; Humans; Kidney Failure, Chronic

Aplastic anemia (AA) is a rare, severe disease of mainly unknown origin. Numerous case history reports have incriminated drugs in the etiology of this disease. Because those reports were questionable, a case-control study was conducted in France between 1985 and 1988. Cases selected from the national register were eligible for inclusion when at least two blood lineages were depressed (hemoglobin < or = 10 g/100 mL and reticulocytes < or = 50 x 10(9)/L, granulocytes < or = 1.5 x 10(9)/L, platelets < or = 100 x 10(9)/L) and when the bone marrow biopsy was compatible with the disease. Using a standardized questionnaire, trained investigators interviewed one AA patient and two groups of controls (two hospitalized patients and one neighbor of the AA patient) matched for age, sex, and interviewer. One hundred forty-seven AA patients, 287 hospitalized controls, and 108 neighbors were interviewed. The occurrence of AA was analyzed by matched design with relation to medical history and drug use during the last 5 years, and specifically during the last year. Three times as many AA patients reported having suffered from clinical hepatitis during the last 6 months than either type of control. Similarly, a higher proportion of AA patients reported a history of chronic immune disorder, mainly rheumatoid arthritis (odds ratio of 6.8), and a previous use of gold salts and D-penicillamine in the 5 previous years (odds ratio of 4.9 for each drug). An excess of colchicine and allo/thiopurinol intake in the 5 previous years was observed among the AA patients (odds ratio equal to 4.1 and 3.6, respectively). These results for gold salts, D-penicillamine, and colchicine were confirmed when looking for drug use within the last year. A moderate risk was associated with acetaminophen or salicylate intake during the 5 previous years or during the last year (odds ratio between 1.8 and 2.0). The frequent use of salicylates within the last year was associated with a high risk of AA (odds ratio of 5.0). A high risk was also associated with indolic derivative intake but only when comparing AA patients to neighbor controls. No association could be evidenced with diclofenac intake, whatever the control group. Differences observed with recently published studies suggest that targeted studies on each category of drugs according to the treated pathologies should be initiated.

Topics: Adolescent; Allopurinol; Anemia, Aplastic; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Child; Colchicine; France; Gold; Hepatitis, Viral, Human; Humans; Medical Records; Penicillamine

A 43 year old female patient with chronic renal failure originated from polycystic kidney disease was admitted with pancytopenia. Prior to the admission, she had a history of taking allopurinol for 3 months. Allopurinol was discontinued immediately and she was treated with blood transfusion (platelet and RBC) and fluoxymesterone. The lymphocyte stimulation tests were negative for allopurinol and oxipurinol. The determination of serum levels of allopurinol and oxipurinol was disclosed to be not so high compared with other patients treated with allopurinol. On 45th day after admission, she was transfused with bone marrow from her elder brother. Thereafter bone marrow finding of the patient began to improve despite the lack of bone marrow engraftment. For further improvement, pulse treatment with corticosteroid was carried out. Although the pathophysiology of allopurinol-induced aplastic anemia remains unknown, it is interesting to note that bone marrow transfusion and pulse treatment with corticosteroid seemed effective in this case.

Topics: Adult; Allopurinol; Anemia, Aplastic; Blood Transfusion; Bone Marrow Transplantation; Female; Humans; Kidney Failure, Chronic; Methylprednisolone; Polycystic Kidney Diseases

A rare case of aplastic anemia which was considered to be induced by allopurinol was reported. A 48-year-old female had suffered from urolithiasis and chronic renal insufficiency. She was administered allopurinol for hyperuricemia for 4 months, and subsequently developed severe pancytopenia and bone marrow suppression. After stopping of allopurinol administration, she was administered prednisolone but died of gastro-intestinal tract bleeding and sepsis on the 21th hospital day, without hematological recovery.

Topics: Allopurinol; Anemia, Aplastic; Female; Humans; Kidney Failure, Chronic; Middle Aged; Uric Acid

Topics: Aged; Allopurinol; Anemia, Aplastic; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged

Topics: Allopurinol; Anemia, Aplastic; Humans; Male; Middle Aged; Uric Acid

Topics: Adult; Allopurinol; Anemia, Aplastic; Humans; Kidney Failure, Chronic; Male

Topics: Adult; Allopurinol; Anemia, Aplastic; Azathioprine; Blood Transfusion; Drug Interactions; Humans; Kidney Failure, Chronic; Kidney Transplantation; Leukemia, Myeloid; Leukocytes; Male; Transplantation, Homologous

Topics: Allopurinol; Anemia, Aplastic; Azathioprine; Drug Interactions; Drug Therapy, Combination; Gout; Humans; Male; Middle Aged

Topics: Adult; Allopurinol; Anemia, Aplastic; Antineoplastic Agents; Bone Marrow; Cyclophosphamide; Depression, Chemical; Drug Synergism; Female; Hematopoiesis; Humans; Leukopenia; Male; Thrombocytopenia; Time Factors

Topics: Adolescent; Allopurinol; Anemia, Aplastic; Drug Synergism; Humans; Male; Mercaptopurine