picibanil and Anemia--Hemolytic

Recent reports have advocated treatment of congenital chylothorax with chemical pleurodesis via intrapleural administration of OK-432. Severe complications have not been reported, but recently we have encountered a life-threatening case of massive hemolysis after the procedure. The hemoglobin of the infant decreased from 8.7 to 3.1 g/dl within 48 h, with concomitant severe hyperbilirubinemia (472 μmol/l) requiring exchange transfusion. Frontline neonatologists should be aware of this rare but potentially life-threatening adverse reaction. In addition, it is possible that a longer indwelling time (3.5 vs. 0.5 h) for OK-432 pleurodesis may alter the therapeutic response.

Topics: Anemia, Hemolytic; Chylothorax; Exchange Transfusion, Whole Blood; Female; Hemoglobins; Humans; Hyperbilirubinemia; Infant; Picibanil; Pleurodesis

In the course of administration of an immunopotentiator, streptococcal agent OK-432, a patient with lung cancer was found to have severe anemia and a strongly positive antiglobulin test. In the absence of the drug, eluates from the patient's erythrocytes reacted strongly by the indirect antiglobulin test with a panel of washed Group O erythrocyte samples. The eluated antibody was composed of monoclonal IgG1-lambda. Upon discontinuing the drug the patient's hemoglobin level increased slowly with concomitant normalization of the reticulocyte count. Although very rare, drug-induced immune hemolytic anemia should be included in the list of adverse effects of immunopotentiators. This is the first reported case of immune hemolytic anemia associated with OK-432.

Topics: Aged; Anemia, Hemolytic; Antibodies, Monoclonal; Biological Products; Blood Grouping and Crossmatching; Carcinoma, Small Cell; Haptoglobins; Hemoglobins; Humans; L-Lactate Dehydrogenase; Lung Neoplasms; Male; Picibanil; Serologic Tests