A Case of Drug Induced Pure Red Cell Aplasia in Comatose Patient

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We report a case of drug-induced pure red cell aplasia (PRCA) in a patient who became comatose after a subarachnoid hemorrhage. The patient had no subjective symptoms, and anemia was the only hematologically abnormal finding. Neurosurgical patients are frequently treated with the anti-epileptic agent diphenylhydantoin to prevent epilepsy, but several papers have reported diphenylhydantoin-induced PRCA. When treated with anti-epileptic agents, patients are at risk for skin reactions, neurogenic disorders, and other side effects when excessive doses are administered. Here, no causative medical agent was identified because the patient had been administered several medical agents, including diphenylhydantoin, which have anemia as a side effect. Dosages of these agents were, however, within the normal range and the blood concentration of diphenylhydantoin was below the standard limit at the time anemia developed. Since comatose patients cannot report subjective symptoms, diagnosis of anemia must be made based on objective manifestations and hematological findings. PRCA must be suspected if anemia symptoms appear rapidly in a patient receiving medical agents which have anemia as a side effect. With drug-induced PRCA there is a risk of PRCA even when the patient is administered standard drug dosages. If anemia is diagnosed, the causative drug must be discontinued immediately.
一般社団法人日本救急医学会の論文