medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-1-49-56medalphabet-1952Research ArticleКОМОРБИДНЫЕ СОСТОЯНИЯCOMORBIDITYЛекарственно-индуцированная гемолитическая анемияDrug‑induced hemolytic anemiahttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, д. м. н., проф., зав. кафедрой терапии и полиморбидной патологии. eLibrary SPIN: 3910-6585

Москва

Ostroumova Olga D.

Moscow

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-2619-1592БлизнюкС. А.BliznyukS. A.

Близнюк Светлана Александровна, к. м. н., врач-кардиолог кардиологического отделения для больных с острым инфарктом миокарда № 28. eLibrary SPIN: 6248-2198

Москва

Bliznyuk Svetlana A.

Moscow

sabliznyuk@mail.ruhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович, к. м. н., доцент кафедры терапии и полиморбидной патологии. eLibrary SPIN: 9212-6010

Москва

Kochetkov Alexey I.

Moscow

ak_info@list.ruКомароваА. Г.KomarovaA. G.

Комарова Анна Григорьевна, к. м. н., врач-кардиолог, зам. гл. врача по региональному сосудистому центру. eLibrary SPIN: 30926789

Москва

Komarova Anna G.

Moscow

bellis-06@mail.ruФГБОУ ДПО «Российская медицинская академия непрерывного последипломного образования» Минздрава РоссииРоссияRussian Medical Academy for Postgraduate Continuous EducationRussian FederationГБУЗ г. Москвы «Городская клиническая больница имени С. П. Боткина Департамента здравоохранения Москвы»РоссияCity Clinical Hospital n. a. S. P. BotkinRussian Federation20210904202101Коморбидные состояния (1)4956Copyright © Остроумова О.Д., Близнюк С.А., Кочетков А.И., Комарова А.Г., 20212021Остроумова О.Д., Близнюк С.А., Кочетков А.И., Комарова А.Г.Ostroumova O.D., Bliznyuk S.A., Kochetkov A.I., Komarova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1952

Одной из причин развития гемолитической анемии (ГА) могут быть лекарственные средства, в том числе некоторые антибактериальные, нестероидные противовоспалительные, противоопухолевыми и антигипертензивные препараты. Установлено, что наиболее часто лекарственноиндуцированная гемолитическая анемия (ЛИГА) развивается на фоне приема антибактериальных препаратов. Истинная распространенность ЛИГА не известна и приблизительно составляет один случай на 1,0–1,2 млн пациентов. Механизмы возникновения ЛИГА подразделяются на иммунные и метаболические (неиммунные). Первый механизм связан с формированием гаптенов, второй вариант – с формированием иммунных комплексов, третий опосредован образованием истинных аутоантител к эритроцитам, четвертым вариантом иммунного механизма возникновения ЛИГА является неиммунологическая абсорбция белка на мембранах эритроцитов. Факторы риска развития ЛИГА полностью не установлены. Наиболее распространенным наследственным фактором риска развития ЛИГА является дефицит глюкозо-6-фосфатдегидрогеназы. Основным методом диагностики ЛИГА является прямой антиглобулиновый тест (прямая проба Кумбса). Важное значение имеет временная связь между приемом препарата-индуктора и развитием симптомов ГА. Стратегия лечения ЛИГА определяется тяжестью заболевания. Во всех случаях лечение должно быть начато с выявления и отмены лекарственного средства, инициировавшего возникновение ГА. При развитии тяжелой ГА может потребоваться проведение гемодиализа. Профилактика ЛИГА предполагает отказ от применения лекарственных препаратов, связанных с высоким риском ее развития.

One of the reasons for the development of hemolytic anemia (HA) can be drugs, including some antibacterial, non-steroidal anti-inflammatory, antitumor and antihypertensive drugs. It was found that the most common drug-induced hemolytic anemia (DIHA) develops against the background of taking antibacterial drugs. The true prevalence of DIHA is not known and is approximately one case per 1.0–1.2 million patients. The mechanisms of the occurrence of DIHA are divided into immune and metabolic (non-immune). The first mechanism is associated with the formation of haptens, the second option – with the formation of immune complexes, the third option is mediated by the formation of true autoantibodies to red blood cells, the fourth option of the immune mechanism of the occurrence of DIHA is non-immunological protein absorption on the membranes of red blood cells. The risk factors for the development of DIHA are not fully established. The most common hereditary risk factor for DIHA is glucose-6-phosphate dehydrogenase deficiency. The main method of diagnosing DIHA is a direct antiglobulin test (direct Coombs’ test). The temporal relationship between the use of the inducer drug and the development of HA symptoms is important. The treatment strategy of DIHA is determined by the severity of the disease. In all cases, treatment should be initiated with the identification and withdrawal of the drug that initiated the occurrence of HA. With the development of severe HA, hemodialysis may be required. Prevention of DIHA involves avoiding the use of drugs associated with a high risk of its development.

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The authors declare that there are no conflicts of interest present.