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Mefenamic acid induced autoimmune hemolytic anemia- A case report

Immune hemolytic anemia (IHA) is an uncommon adverse effect of a wide variety of drugs. The incidence is on the rise due to the extensive use of nonsteroidal anti-inflammatory drugs (NSAID). Mefenamic acid is the most common among NSAIDs causing AIHA by an autoimmune mechanism. We are presenting a case of three years old child presented with history dark colored urine, severe anemia, and jaundice after taking mefenamic acid for fever. Investigations revealed leucocytosis, hyperbilirubinemia, raised reticulocyte count, and negative direct Coombs test. The urinalysis demonstrated proteinuria, hematuria, and pus cell of 18-20/HPF. The urine for free hemoglobin was positive. As all the clinical, as well as investigation reports, were suggestive of the autoimmune hemolytic anemia except for the negative cooms test, the child was diagnosed to be a case of Coombs-negative autoimmune hemolytic anemia (Mefenamic induced) with urosepsis. He was managed conservatively by withdrawing the offending drug, and the latter steroid was added. The child became asymptomatic after a week. While investigating for hemolysis, Coombs-negative autoimmune hemolytic anemia should always be kept in the differentials. Self-remission has been described, especially in children. Withdrawing the offending medication and instituting steroids usually suffice in alleviating the condition.