Alectinib-induced Immune Hemolytic Anemia in a Patient with Lung Adenocarcinoma

Abstract

Drug-induced immune hemolytic anemia (DIIHA) is a rare condition with an increasing incidence associated with the frequent use of certain drugs. An 85-year-old woman with lung adenocarcinoma prescribed alectinib complained of dyspnea on exertion at our hospital. Based on her laboratory tests results on admission, we focused on the clinical course of anemia and hemolysis progression after alectinib administration. The patient's anemia and hemolysis gradually improved after discontinuation of alectinib, leading to a diagnosis of alectinib-induced IHA, presented here as the first case encountered in a patient with lung adenocarcinoma. Furthermore, we discuss the importance of correlating clinical laboratory findings in DIIHA.

Keywords: alectinib; anaplastic lymphoma kinase; coombs-negative autoimmune hemolytic anemia; drug-induced immune hemolytic anemia; lung cancer.

Figure 1.

Spherocytes (arrow) were observed in peripheral blood smear on admission.

Figure 2.

Chest computed tomography (CT) on admission. (A) Chest CT from six months earlier. (B) Chest CT six months later showing no marked change in the primary tumor in left S¹⁰ compared with (A). (C) Abdominal CT of spleen taken two years earlier. (D) Abdominal CT showing spleen enlargement compared with (C). Dimensions, 78×33×70 mm→87×41×80 mm.

Figure 3.

Changes in blood levels of hemoglobin, LDH, and T-Bil after the administration of alectinib. The hemoglobin level decreased, whereas the LDH and T-Bil levels gradually increased after alectinib administration. LDH: lactate dehydrogenase, T-Bil: total bilirubin

Figure 4.

Changes in blood levels of hemoglobin, LDH, and T-Bil after the discontinuation of alectinib. The patient required blood transfusion only once on admission day 8 for dyspnea on exertion. The hemoglobin level then increased, while the LDH and T-Bil levels decreased gradually after alectinib discontinuation. LDH: lactate dehydrogenase, T-Bil: total bilirubin