Diclofenac-induced antibodies against RBCs and platelets: two case reports and a concise review

BACKGROUND: Diclofenac has frequently been implicated as the cause of immune hemolytic anemias and less frequently of immune thrombocytopenia. The presence of the causative antibodies has only been demonstrated in patients with immune hemolytic anemia, but not yet in patients with thrombocytopenia. The cases of two patients in whom diclofenac simultaneously induced antibodies against platelets and RBCs are reported. STUDY DESIGN AND METHODS: The investigation was carried out with standard serologic tests for detection of antibodies against platelets and RBCs. The patients' sera were tested in the presence and absence of diclofenac and its metabolites. RESULTS: One of the two patients developed severe hemolysis and significant thrombocytopenic purpura. The other patient developed significant thrombocytopenia but no hemolysis. Both patients had a positive DAT and drug- and/or metabolite-dependent antibodies against RBCs and platelets. CONCLUSION: Based on our findings and those of other investigators, we believe that diclofenac leads to the production of antibodies against RBCs and/or platelets.     

The protective effect of erythropoietin and dimethylsulfoxide on ischemia-reperfusion injury in rat ovary

Objectives

The aim of this study was to investigate the effects of erythropoietin and dimethylsulfoxide in the recovery from ischemia-reperfusion injury in an experimental rat adnexal torsion model.

Study design

Thirty-six Wistar-albino rats were divided into six groups. Except for the sham operation group, all groups were subjected to left unilateral adnexal torsion for 3 h. Erythropoietin and dimethylsulfoxide were intraperitoneally administered 30 min before the detorsion operation. Malondialdehyde and nitric oxide levels were detected from both the plasma and the tissue samples. The sections of the tissues were evaluated histologically. The results were analyzed by a one-way analysis of the variance (ANOVA) followed by the Duncan test for multiple comparisons using computer software, SPSS Version 15.0 for Windows.

Results

This study demonstrated that dimethylsulfoxide and erythropoietin pretreatment attenuated ischemia-reperfusion-induced lipid peroxidation, prevented post-ischemic ovarian injury and helped to maintain the ovarian morphology. Malondialdehyde levels of plasma and ovary were higher in the torsion and detorsion groups than the sham group. This showed that ischemia-reperfusion had caused lipid peroxidation of the ovarian tissue, thus leading to oxidative damage. One of the major findings of this study is that malondialdehyde was significantly decreased in the plasma of rats who were pre-treated with dimethylsulfoxide and erythropoietin before detorsion. This suggests that dimethylsulfoxide and erythropoietin might prevent oxidative damage in ovarian ischemia-reperfusion injury. Histological examination confirmed that reperfusion caused more detrimental effects than only ischemia, which could be at least partially prevented by dimethylsulfoxide and erythropoietin administration prior to detorsion.

Conclusion

Erythropoietin and dimethylsulfoxide may have beneficial effects in ischemia-reperfusion injury in ovarian torsion.     

Dry eye findings worsen with anticholinergic therapy in patients with urge incontinence

Introduction and hypothesis

To evaluate the effects of oral anticholinergic (OAC) drugs on tear secretion in women with overactive bladder over a 3-month follow-up period.

Methods

In this prospective study, 108 women with a diagnosis of overactive bladder were evaluated. All patients were examined ophthalmologically at baseline (day 0), and after 1 month (day 30) and 3 months (day 90) of OAC treatment. Tear film break-up time (BUT) and Schirmer 1 test results were recorded. The subjective complaints of the patients including dry mouth, and burning, dryness and foreign body sensation in the eyes, were also recorded. The chi-squared test or the paired sample t test as appropriate, was used for statistical analysis.

Results

The mean age of the patients was 51.8?±?9.2 years (30 – 69 years). The most frequent subjective complaints were dry mouth and dry eyes and both complaints were significant on both day 30 and day 90. Both tear film BUT and Schirmer 1 test results were significantly lower on day 30 and day 90. Dry eye measurement values worsened with prolongation of OAC treatment (p?=?0.037 and p?=?0.012 for BUT, and p?=?0.046 and p?=?0.035 for Schirmer 1 test, on day 30 and day 90, respectively).

Conclusions

OAC treatment in women with overactive bladder significantly and progressively affects tear secretion.