This case report details an extremely rare disease called drug-induced immune hemolytic anemia (DIIHA) that developed in a 52-year-old man once he started using the drug dapagliflozin (Farxiga), a drug often prescribed for diabetes. The report speculates that this could be the first to link this particular drug to this unusual disorder. DIIHA is a dangerous side effect wherein the immune system abnormally reacts against and destroys red blood cells upon exposure to a drug. While extremely uncommon, affecting 1-2 people per million individuals per year, it is life-threatening unless treated.
Two weeks since he was initiated on dapagliflozin, the patient presented with some of the ensuing symptoms: weakness, shortness of breath, jaundice, dark-colored urine, and right-sided flank pain. Tests on arrival to the emergency room revealed the presence of anemia due to hemolysis, as indicated by low red blood cell counts, increased bilirubin and liver enzyme levels, increased lactate dehydrogenase (LDH), and low haptoglobin. All of these results indicated the ongoing destruction of red blood cells in his body.
Physicians suspected immediately that the issue was due to dapagliflozin, so they discontinued the drug. The patient received blood transfusions, a brief course of steroid medication, and other supportive care. His condition stabilized, with evidence that his body was making new red blood cells, a sign that the treatment was working. This case highlights significant medical takeaways, including the significance of considering DIIHA whenever a patient becomes anemic following the initiation of new medications and the necessity of a thorough review of their medication history.
Diagnosis of DIIHA may be challenging since it can be mimicked by other forms of hemolytic anemia in the laboratory, but prompt withdrawal of the offending drug is important in recovery. Patients who undergo this rare reaction need to be avoided from taking the drug in the future, as well as related drugs, and need to be followed up by a hematologist to confirm continued health. The report shows the critical necessity of early detection of this rare condition to avoid dire consequences.
