Frågedatum: 2004-04-30
RELIS database 2004; id.nr. 20550, DRUGLINE
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Can sertraline be a cause of haemolytic anemia or anemia in general?/nThe question concerns a 62-ye



Fråga: Can sertraline be a cause of haemolytic anemia or anemia in general? The question concerns a 62-year-old man who was splenectomized approximately one year ago due to a severe haemolytic anemia of unknown etiology. He has recovered since, and had a hemoglobin count of 142 in the beginning of December 2003. About the same time sertraline therapy was commenced. In early January the patients hemoglobin count was 128, with a slight elevation of s-LD (serum lactate dehydrogenase) Platelet and WBC counts are normal. Erythrocyte indices and fecal blood analysis are not available. The patient is asymtomatic.

Sammanfattning: Sertraline may induce a relative bleeding diathesis, but the literature does not contain any certain reports of an association with haemolytic anemia.

Svar: A well known haematological effect of sertraline and the whole class of selective serotonin reuptake inhibitors (SSRI) is a certain effect on platelet aggregation due to serotonin depletion. This effect has been mirrored in several cohort and case control studies as a relatively well documented inreased risk for gastrointestinal (GI) hemorrhage. Whereas the risk of GI hemorrhage is elevated threefold on using SSRI, it is increased 15-fold when SSRI are combined with NSAIDs; which are common over the counter medications. This has been reviewed in previous Drugline documents. (1,2)

In the case in question, however, given the case history and the elevated s-LD, a possible association between sertraline and haemolytic anemia is in focus. The standard literature sources and Medline do not contain any case reports linking sertraline with haemolytic anemia. The files of SADRAC, the Swedish register of adverse drug reactions, do not contain any reports of haemolytic anemia as a side effect of sertraline (3). The WHO database contains 6 reports of haemolytic anemia as a possible consequence of sertraline treatment (4). No details of these cases are available, however. It is worthwhile noting that analysis of likelihood of causality is not always conducted on the reports in the WHO adverse drug reaction database.

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