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THE I ANTIGEN AS AN IMMUNE COMPLEX RECEPTOR IN A CASE OF HAEMOLYTIC ANAEMIA INDUCED BY AN ANTIHISTAMINIC AGENT

It is accepted that drug-induced haemolytic anaemia may be due to an immune complex mechanism. The drug combines with an antibody in the patient’s serum to form circulating immune complexes which are secondarily and non-specifically adsorbed on the erythrocyte membrane, often activating complement and causing haemolysis (Worlledge, 1973; Pla et al, 1976; Martinez-L. Letona et a!, 1977; Petz & Garratty, 1980; Ribera et al, 1981). Erythrocytes have been considered ‘innocent bystanders’ in this reaction (Dameshek, 1965). We had the opportunity to study a case of haemolytic anaemia induced by an antihistaminic agent (dexachlorpheniramine maleate), in which adsorption of the immune complexes only took place on the erythrocytes with the I antigen. A 47-year-old woman, who 3 weeks before admission had a flu-like syndrome, was treated with dexachlorpheniramine maleate for 3 d (4 mg/d) and developed progressive anaemia and conjunctival jaundice. On admission, the analytical data included: haematocrit, 22%; haemoglobin, 8.2 g/dl; reticulocyte count, 16.6%; haptoglobins, 0 mg%; leucocyte count, 8.5 x lo9/]; platelets 320 x 109/l; indirect bilirubin, 1.5 mg/dl; LDH, 383 I.U./l. The direct antiglobulin test was positive (3 +). Immuno-haematological studies supported the diagnosis of dexachlorpheniramine maleate-induced haemolytic anaemia (Table I). These findings suggest that, in our case, there is a close relationship between the erythrocytic I antigen and adsorption of immune complexes, as this did not take place when cord and adult Oi cells were used.