Ibuprofen-induced hemolytic anemia

Abstract

Drug-induced immune hemolytic anemia is a rare condition with an incidence of 1 per million of the population. We report the case of a 36-year-old female who presented to the emergency department complaining of shortness of breath and dark colored urine. Physical examination was significant for pale mucous membranes. The patient reported using ibuprofen for a few days prior to presentation. Complete blood count performed before starting ibuprofen revealed normal platelets and hemoglobin values. On admission, the patient had evidence of hemolytic anemia with hemoglobin of 4.9 g/dL, hematocrit of 14.2%, lactate dehydrogenase 435 IU/L, and reticulocytosis 23.2%. Further testing ruled out autoimmune disease, lymphoma, and leukemia as etiologies for the patient's new onset hemolytic anemia. Ibuprofen was immediately stopped with a gradual hematologic recovery within 3 days.

Figure 1

Peripheral blood smear shows microspherocytes (black arrows), polychromasia (white arrows), and normal looking red blood cells with central pallor (red arrows).