mechanism lead to drug related antibodies

immune complex: prototype drugs

quinidine

phenacetin

immune complex: Ig class

IgG or IgM

immune complex: DAT results

postive often C3 only but IgG may be present

immune complex: eluate

often negative

immune complex: frquency of hemolysis

small doses of drugs may cause acute intravasular hemolysis with hemoglobinemia/hemoglobulinuria; renal failure common

drug absorption: prototype drug

penicillin

streptomycin

cephalosporins

drug absorption: Ig class

IgG

drug absorption: DAT results

strongly postive

drug absorption: eluate

often negative

drug absorption: frequency of hemolysis

3-4% of pt on large doses of penicillin, most common causes of immune hemolysis, usually extravascular

membrane modication: protoype drugs

cephalosporins

membrane modication: Ig class

many plasma proteins

membrane modication: DAT results

positive bc of variety of serum proteins

membrane modication: eluate

negative

membrane modication: frequency of hemolysis

no hemolysis; however 3% of pt receiving the drug develop postive DAT

methyldopa induced: protoytpe drug

methyldopa (aldomet)

methyldopa induced: Ig class

Ig

methyldopa induced: DAT results

strong positive

methyldopa induced: eluate

positive warm autoantibody identical

methyldopa induced: frequency of hemolysis

0.8% of pt develop a hemolytic anemia that mimics a warm AIHA.

15% of pt receiving methyldopa develop a postive DAT