Causes of Autoimmune Hemolytic Anemia

Metformin and Lecithin Added to the List of Drugs Implicated in AIHA

Feb 7, 2009 Elaine Moore

Medications such as penicillin and methotrexate are well known causes of autoimmune hemolytic anemia (AIHA). Recently, metformin and lecithin have been added to the list.

Autoimmune hemolytic anemia is an autoimmune disorder in which red blood cells are destroyed, causing a severe, acute form of anemia. Besides being triggered by medications, AIHA can occur in conjunction with other autoimmune diseases, especially systemic lupus erythematosus (SLE), myasthenia gravis, and multiple sclerosis, and it can be triggered by infectious diseases, including human parvovirus B19 infection.

Drug Causes of AIHA

Nearly 100 drugs have long been known to cause autoimmune hemolytic anemia. Offending agents include the anti-malarial compounds such as quinine and chloroquine, anticonvulsant medications such as Dilantin, non-steroidal anti-inflammatory drugs (NSAIDs) such as mefenemic acid and acetaminophen, and the anti-Parkinson's drug levodopa, For a complete list, see the resource section. In addition to drugs listed, the widely prescribed anti-diabetic agent Metformin and the dietary supplement lecithin have recently been implicated in triggering autoimmune hemolytic anemia.

Illnesses Associated with AIHA

Autoimmune hemolytic anemia is known to occur in patients infected with infectious mononucleosis, cytomegalovirus (CMV), Mycoplasma pneumonia, Epstein-Barr virus (EBV), human immunodeficiency virus (HIV), viral hepatitis, and human parvovirus B-19. AIHA is also known to develop in patients with many different autoimmune diseases such as Sjogren’s syndrome as well as chronic lymphocytic leukemia (CLL), lymphoproliferative disorders, ovarian cancer, and blood cancers such as non-Hodgkin’s lymphoma.

Metformin

Metformin is a biguanide antidiabetic drug that has been implicated in several cases of hemolytic anemia, including one fatality. In the fatality, metformin caused a rapidly fatal hemolytic anemia in a 56-year-old Caucasian man with type 2 diabetes mellitus who had recently started metformin. Over a course of 4 days, the patient’s condition deteriorated and he did not respond to steroid medications. Twelve hours after admission to the hospital, the patient died of a fatal cardiorespiratory arrest related to a low hemoglobin level.

Lecithin

The dietary supplement lecithin was found to cause hemolytic anemia in a 38-year old Greek woman using high doses (1200 mg up to 3-4 times daily for 10 days) for weight loss. The authors of this study warn that any drug or supplement patients are taking should be investigated in newly diagnosed cases of AIHA.

Resources:

George Garrity, Drugs Known to Cause AIHA or a positive DAT , Traq Program of the PBCO, accessed Jan 10, 2009

I.G. Lentzas, P. Papagiannopoulos, I. Nikilaidis, and V. Garmiri, Idiopathic Autoimmune hemolytic anemia due to a lecithin overdose: a case report, Cases J. 2009, Jan; 21;2(1).

C.D. Packer, T Hornick, S Augustine, Fatal hemolytic anemia associated with metformin: A case report, J Medicine Case Reports, Sept 2008;2:300.

The copyright of the article Causes of Autoimmune Hemolytic Anemia in General Medicine is owned by Elaine Moore. Permission to republish Causes of Autoimmune Hemolytic Anemia in print or online must be granted by the author in writing.

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