Drug-induced immune hemolytic anemia occurs when certain drugs start an immune reaction against red blood cells. In some instances, the drugs interact with the red blood cell membrane, causing the cell to become antigenic. This means the body identifies these cells as not belonging to the body. Antibodies form against the red blood cells. The antibodies attach to red blood cells and result in their premature destruction. This condition is rare in children.

Drugs that can cause immune hemolytic anemia include the following:

• Penicillin and its derivatives
• Cephalosporins
• Levodopa
• Methyldopa
• Quinidine
• Some anti-inflammatory drugs

There are many other rarer causes of drug-induced hemolytic anemia. Drug-induced hemolytic anemia is most often associated with G6PD deficiency. However, G6PD deficiency and hemolysis is due to oxidative stress in the red cell, not an autoimmune phenomenon.

• Fatigue
• Pale color
• Shortness of breath
• Rapid heart rate
• Yellow skin color (jaundice)
• Dark urine

• A direct Coombs' test is positive.
• An indirect Coombs' test is positive if the offending drug is added to the test.
• Indirect bilirubin levels are elevated.
• Serum haptoglobin may be low.
• Hemoglobin may be present in the urine.
• Hemosiderin may be present in the urine.
• Urine and fecal urobilinogen are increased.
• An absolute reticulocyte count is elevated.
• A CBC shows red blood cell count and hemoglobin are low.

• Death caused by severe anemia rarely occurs.
• Transfusion can cause a transfusion reaction.