What is drug-induced hemolytic anemia?

• Immune (antibody-mediated) hemolysis, which can be drug dependent or drug-independent • Oxidative damage and Methemoglobinemia • Thrombotic microangiopathy (TMA) In drug-dependent reactions, the drug binds to the RBC surface and becomes part of the antigen with which the antibody interacts • Penicillin type, drug remains on RBC, and is required for antibody binding • Immune complex type, the drug causes formation of immune complexes that bind to the RBCs and cause complement activation • Passive absorption administration of antibody preparations introduces antibodies that can react with the recipients RBCs. eg IVIG • In drug-independent, It can cause immune hemolysis several weeks to months after drug initiation. drug alters RBC membrane