Drug-induced haemolytic anaemia results from a type II immune reaction in which antibodies to the drug or its metabolite(s) attack blood cells. Antigens on the cell's surface combine with antibody and complement to stress the cell to the point of destruction. The cell damage causes anaemia. There is an increased production of bilirubin, although a healthy liver can excrete six times the normal load before unconjugated bilirubin accumulates in the plasma; jaundice is therefore mild. Severe haemolysis can result in prerenal uraemia and renal failure. Other related immunological reactions are referred to below.
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