rifampin and Anemia--Hemolytic

Daily rifampin therapy is associated with minimal adverse effects, but administration on an intermittent or interrupted basis has been associated with severe immunoallergic reactions such as hemolytic anemia, acute renal failure, and disseminated intravascular coagulation. We describe a patient with Mycobacterium leprae infection who experienced recurrent episodes of disseminated intravascular coagulation after intermittent exposures to rifampin, and review eight previously reported cases of rifampin-associated disseminated intravascular coagulation. In six (75%) cases, previous exposure to rifampin was reported and seven (87.5%) patients were receiving the medication on an intermittent or interrupted basis. Clinical features of rifampin-associated disseminated intravascular coagulation included fever, hypotension, abdominal pain, and vomiting within hours of ingestion. Average time to reaction was 3-6 doses if rifampin was being administered on a monthly schedule. Three (37.5%) of eight reported cases were fatal. A complete history of previous exposure to rifampin is recommended before intermittent therapy with this medication.

Topics: Abdominal Pain; Aged; Anemia, Hemolytic; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Female; Fever; Humans; Hypotension; Leprosy; Rifampin; Vomiting

A 71-year-old woman was treated for a relapsing pulmonary tuberculosis with reinstitution of rifampicin after a medication-free interval of 2 years. After ingestion of the second dose, she developed severe hemolytic anemia and acute renal failure (ARF) necessitating dialysis. We demonstrated the presence in the patient's serum of rifampicin-dependent immunoglobulin G (IgG) and IgM antibodies, which caused red blood cell lysis through interaction with the I antigen on the erythrocyte surface. A review of the literature yielded 48 cases of rifampicin-associated renal failure. A subgroup of 37 patients could be distinguished, which, analogous to our case, suddenly developed ARF and frequently also developed hemolytic anemia and/or thrombocytopenia during intermittent or interrupted treatment. Regarding the pathogenesis of the ARF, renal biopsy consistently revealed tubular lesions. Although intravascular hemolysis with hemoglobinuria may play a role, it is not uniformly present. Our demonstration of an antibody with anti-I specificity provides a possible explanation. The I antigen is also expressed on tubular epithelium and may, therefore, be the target structure through which rifampicin-antibody complexes lead to tubular cell destruction. The other cases of rifampicin-associated ARF were unrelated to this subgroup: two cases of rapidly progressive glomerulonephritis, five cases of acute interstitial nephritis, and four cases of light chain proteinuria were recorded.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Antibiotics, Antitubercular; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Anemia, Hemolytic; Digestive System; Humans; Influenza, Human; Liver; Rifampin; Skin; Syndrome; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Acetamides; Anemia, Hemolytic; Aniline Compounds; Animals; Clofazimine; Dapsone; Disease Models, Animal; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Leprosy; Methimazole; Mice; Mycobacterium leprae; Phenyl Ethers; Rifampin; Sulfonamides; Thiosemicarbazones; Thiourea

Topics: Acute Kidney Injury; Anaphylaxis; Anemia, Hemolytic; Dose-Response Relationship, Drug; Drug Hypersensitivity; Humans; Hypotension; Purpura, Thrombocytopenic; Rifampin

Topics: Abdominal Pain; Adult; Anemia, Hemolytic; Antibiotics, Antitubercular; Female; Humans; Radiography, Thoracic; Recurrence; Rifampin; Tuberculosis, Pulmonary

Multidrug therapy for leprosy is currently done with dapsone, clofazimine and rifampicin. Dapsone is known to cause hemolytic anemia (HA) and this adverse event during MDT seems to be more frequent than reported. The aim of this report is to discuss and grade HA due to dapsone during MDT treatment for leprosy.. This is a retrospective study of 194 leprosy patients from a Leprosy Control Programme Unit in Vit6ria-ES, Brazil.. HA was observed in 48 (24.7%) patients and occurred within the first 3 months in 51% of these. Mean hematocrit levels fell from 38.5 to 31.5 and hemoglobin from 12.8 to 10.3.. Dapsone used in the MDT regime for leprosy decreases the hematocrit and hemoglobin levels due to a low grade hemolysis, which can result in significant anemia.

Topics: Adolescent; Adult; Aged; Anemia, Hemolytic; Brazil; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Follow-Up Studies; Hematocrit; Hematologic Tests; Hemoglobins; Hemolysis; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Retrospective Studies; Rifampin; Treatment Outcome; World Health Organization; Young Adult

To present a case of acute brucellosis triggering acute hemolytic anemia in a subject with glucose-6-phosphate dehydrogenase (G6PD) deficiency.. A 17-year-old male patient presented with fever, malaise and jaundice. His blood and bone marrow cultures yielded Brucella species. In addition, he was found to have acute hemolytic anemia due to previously undiagnosed G6PD deficiency. He was started on folic acid supplementation and given a combination of doxycycline and rifampicin for 6 weeks. His response to antibiotic therapy was optimal; the hemolytic anemia resolved. There were no further episodes of hemolysis.. This case showed that the differential diagnosis of acute hemolytic anemia in subjects with G6PD deficiency should include brucellosis, especially in regions where the infection is endemic.

Topics: Adolescent; Anemia, Hemolytic; Anti-Bacterial Agents; Brucellosis; Doxycycline; Folic Acid; Glucosephosphate Dehydrogenase Deficiency; Hematinics; Humans; Male; Rifampin

Topics: Adult; Anemia, Hemolytic; Cyclosporine; Female; Humans; Plasma Exchange; Rifampin; Stem Cell Transplantation

Multidrug therapy (WHO/MDT) in multibacillary leprosy consists of treatment with rifampicin, dapsone and clofazimine. However, adverse effects can cause the patient to abandon treatment. We report on a patient who presented agranulocytosis and hemolytic anemia associated with this treatment regime. We also examined the importance of laboratory exams for diagnosis and follow-up of the patient, and for early detection of adverse effects,with a view to improving adhesion to treatment and contributing to the eradication of Hansen's disease as a public health issue.

Topics: Adult; Agranulocytosis; Anemia, Hemolytic; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy; Rifampin

We report two pediatric patients with rifampin-induced hemolysis following treatment with low daily dose rifampin for methicillin-resistant Staphylococcus aureus (MRSA). With the increased use of rifampin to treat MRSA, physicians should be aware that patients receiving rifampin therapy are at risk for hemolysis, even at low daily doses.

Topics: Adolescent; Anemia, Hemolytic; Antibiotics, Antitubercular; Drug Therapy, Combination; Female; Hemolysis; Humans; Infant; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections

Topics: Acute Kidney Injury; Adult; Anaphylaxis; Anemia, Hemolytic; Antibiotics, Antitubercular; Disseminated Intravascular Coagulation; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Liver; Male; Renal Dialysis; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary

Rifampicin re-administration may cause immunologically mediated acute tubulo-interstitial injury. Retrospectively, 170 consecutive cases with acute renal failure (ARF) following re-treatment with rifampicin (71% males, 29% females, age 21 to 68 years) were analysed, which accounted for 12% of all ARF patients treated by two large dialysis referral centres in Romania, Timisoara and Iasi, between 1974-2001 and 1988-2001, respectively. The most frequent clinical features of rifampicin-induced ARF were: Anuria, gastro-intestinal (abdominal pain, nausea, vomiting and diarrhoea) and "flu-like" symptoms. Urine analysis revealed sterile leucocyturia in 54%, proteinuria in 31%, haematuria in 26% and haemoglobinuria in 7% of cases. Haemolytic anaemia was frequent, found in 66% of the patients; half of these had Hct values of < 30%, thrombocytopenia and also more severe renal damage (a longer anuric phase and a slower recovery of the renal function), thus suggesting a severe multi-target autoimmune aggression. The association of hepatic injury--not explained by prior hepatic disease, B or C hepatitis virus infection or history of alcohol abuse--was encountered in 17% of the cases, without a significant influence on the renal and the general outcome. The outcome of rifampicin-induced ARF is generally favourable, with complete recovery of the renal function within 30 days in 52% of the cases and within 90 days in 92% of the cases. The mortality rate was 3.5%, compared to 21% for the overall ARF population treated during the same period (p < 0.05).

Topics: Acute Kidney Injury; Adult; Aged; Anemia, Hemolytic; Antibiotics, Antitubercular; Female; Humans; India; Male; Middle Aged; Retrospective Studies; Rifampin

We report three patients who developed haemolysis following rifampicin treatment. Initially, autoimmune haemolytic anaemia (AIHA) of the warm type and/or an acute haemolytic transfusion reaction (AHTR) was suggested. The direct antiglobulin tests (DAT) were strongly positive for IgG and C3d, and tests for rifampicin-dependent antibodies were positive in all three cases, featuring C-specificity in one case. The outcome was fatal in two out of the three cases, presumably due to belated diagnosis. This shows that rifampicin may stimulate the production of autoantibodies (aab) and/or drug-dependent antibodies (ddab), and that the resulting haemolytic syndrome bears similarities with AIHA and AHTR.

Topics: Adult; Anemia, Hemolytic; Antibiotics, Antitubercular; Antibodies; Autoantibodies; Diagnostic Errors; Fatal Outcome; Female; Hemolysis; Humans; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Anemia, Hemolytic; Female; Humans; Immunoglobulin E; In Vitro Techniques; Lymphocytes; Rifampin; Thrombocytopenia; Toxicity Tests

Rifampin is a drug able to induce adverse reactions involving both the kidney and the hematological system. We observed a case, throughly studied and we deemed worth-while to report it, for some important features that were evident. Transient hemolytic anemia, recoverable acute renal failure, persistent increased titer of anti-platelet antibody lasting also after 3 weeks from the withdrawal of the drug and in spite of corticosteroid therapy, could be explained by the immune mechanisms that are, therefore, postulated.

Topics: Aged; Anemia, Hemolytic; Antibiotics, Antitubercular; Autoantibodies; Blood Platelets; Humans; Male; Rifampin; Thrombocytopenia

Topics: Adult; Anemia, Hemolytic; Antitubercular Agents; Autoimmune Diseases; Biopsy; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Tuberculosis, Lymph Node

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Female; Humans; Rifampin

Topics: Acute Kidney Injury; Anemia, Hemolytic; Female; Humans; Middle Aged; Rifampin

Renal failure is a rare complication associated with the use of rifampin. Intravascular hemolysis leading to acute renal failure following rifampin therapy is extremely rare. Two patients with leprosy who developed hemolysis and acute renal failure following rifampin are reported.

Topics: Acute Kidney Injury; Adult; Anemia, Hemolytic; Hemolysis; Humans; Leprosy; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Rifampin

A 50-year-old woman with primary biliary cirrhosis developed immune hemolytic anemia and renal failure while receiving rifampicin for the treatment of refractory pruritus. Serological studies revealed the presence of rifampicin-dependent antibodies of the IgM class that, when tested against a wide panel of erythrocytes, had anti-I specificity. Subsequently, rifampicin was withdrawn and prednisone treatment instituted, this resulting in a rapid resolution of the hemolysis, whereas hemodialysis was required for recovery of the renal function. A role is suggested for the anti-I specificity of the antibodies in the development of renal failure associated with rifampicin therapy.

Topics: Anemia, Hemolytic; Antibodies; Coombs Test; Female; Hemagglutination; Humans; I Blood-Group System; Immunoglobulin M; Kidney Diseases; Middle Aged; Rifampin

Topics: Adult; Anemia, Hemolytic; Erythrocytes; Female; Humans; Plasma Exchange; Rifampin

We describe a woman with the 'flu' like syndrome and haemolysis whilst on a supervised daily rifampicin regimen for the treatment of pulmonary tuberculosis. Although these are known complications of rifampicin therapy, they often occur when therapy is intermittent or interrupted. Hence the case we describe is unique and is the first of its kind to be reported in Singapore.

Topics: Adult; Anemia, Hemolytic; Diagnosis, Differential; Female; Hemolysis; Humans; Influenza, Human; Rifampin; Time Factors; Tuberculosis, Pulmonary

19 antibodies specific for 11 different drugs were extensively tested in the presence of the drug against a panel of red cells including common and public minus phenotypes. High incidence blood group antigens were shown to be specific receptors for several drug-antibody complexes proving thereby that red blood cells play more than an "innocent bystander" role in drug induced immune hemolytic anemias.

Topics: Acute Kidney Injury; Anemia, Hemolytic; Antigen-Antibody Complex; Blood Group Antigens; Erythrocyte Membrane; Humans; Phenotype; Receptors, Immunologic; Rifampin

Sixteen patients were given high-dose intermittent rifampicin treatment (900 mg twice weekly) in order to record side-effects of the flu-type. Three patients who experienced a febrile reaction were re-challenged under strict hospital supervision with a single dose (900 mg) of rifampicin. Two patients showed a distinct febrile response together with rapidly subsiding symptoms typical of the rifampicin-induced flu-syndrome, whereas the third patient's reaction was clinically different. During the challenge, the changes in a number of laboratory tests were indicative of a mild haemolytic reaction in the two patients with flu-syndrome. Plasma haemoglobin steeply increased within a few hours following the ingestion of the dose. This was associated with an acute increase in the total bilirubin and with a gradual decrease in the blood haemoglobin and haematocrit values. In further support of a drug-induced haemolysis was the findings that both patients showed a distinct reticulocyte response several days after the challenge. No such changes were seen in the third patient, whose reaction was later demonstrated to be related to isoniazid. The flu-syndrome thus may represent a first warning sign of intravasal haemolysis, which, if massive enough, eventually could lead to haemolytic crises and renal failure.

Topics: Anemia, Hemolytic; Bilirubin; Fever; Hematocrit; Hemoglobins; Hemolysis; Humans; Rifampin; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Anemia, Hemolytic; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Rifampicin is a widely used anti-tuberculous drug. Administered daily, only minimal side-effects occur. With intermittent therapy and, as happened in the present case, when the drug is administered after an interruption of treatment, severe adverse reactions [5] (thrombocytopenia, renal failure, and haemolysis) may occur.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Antibodies; Drug Administration Schedule; Humans; Immunoglobulin G; Immunoglobulin M; Male; Rifampin; Time Factors

Topics: Anemia, Hemolytic; Coombs Test; Fever; Humans; Jaundice; Pain; Rifampin; Thrombocytopenia

Topics: Acute Kidney Injury; Agglutination Tests; Anemia, Hemolytic; Antibodies; Female; Hemolysis; Humans; Middle Aged; Rifampin; Tuberculosis, Renal

Topics: Acute Kidney Injury; Adult; Agglutination Tests; Anemia, Hemolytic; Antibodies, Anti-Idiotypic; Antigen-Antibody Reactions; Erythrocytes; Haptens; Humans; Immunoglobulins; Male; Middle Aged; Rifampin; Trypsin

Topics: Adolescent; Anemia, Hemolytic; Antibody Specificity; Drug Hypersensitivity; Female; Humans; Immunoglobulin G; Quinine; Rifampin

Topics: Anemia, Hemolytic; Aniline Compounds; Anti-Bacterial Agents; Dapsone; Drug Resistance, Microbial; Humans; Injections, Intramuscular; Leprosy; Mycobacterium leprae; Phenazines; Rifampin; Sulfonamides; Sulfones; Thioacetazone; Thiourea

Topics: Aminopyrine; Anemia, Hemolytic; Electrophoresis; Erythrocytes; Ethnology; Favism; Glucosephosphate Dehydrogenase; Glucosephosphate Dehydrogenase Deficiency; Humans; Italy; Leukocytes; Molecular Biology; Mutation; Rifampin