Presented is a case report of an 80-year-old man with dyspnoea and
jaundice who died from
autoimmune haemolytic anaemia (AIHA) within 12 hours of arrival at the emergency department. The patient had been taking
tolmetin for
osteoarthritis. On autopsy he was found to have a superficial gastric
adenocarcinoma. A brief presentation on AIHA includes primary (idiopathic) and secondary types. Factors associated with AIHA include nonsteroidal anti-inflammatory drugs (
NSAIDs) and gastric
carcinoma, although a direct cause cannot be demonstrated. After a discussion of the autoimmune mechanism of
drug-associated
hemolysis of which
methyldopa is the prototype, a review of
NSAIDs associated with AIHA is presented. All (18)
NSAID cases of immune
haemolysis were reviewed to determine which were more likely due to an autoimmune mechanism. These included 3 cases with
tolmetin use: one probable and one possibly having an autoimmune basis for
haemolysis, while with the third case immune
haemolysis was by the
drug adsorption mechanism. A review of gastric
carcinoma associated with AIHA reveals only 2 previously reported cases. The associations of
tolmetin use, as well as gastric
carcinoma with AIHA, both rare, are noteworthy but cannot be proven as causative factors with our current level of knowledge and technology.