Abstract：
BACKGROUND: Molecular multitargeted small tyrosine kinase inhibitory (TKI) agents such as axitinib, sunitinib and pazopanib are commonly used in several types of solid tumors. Anemia is not a rare effect of these drugs which may occur at all grades. However, drug-induced immune hemolytic anemia (IHA), a very rare condition is distinctive from other types of anemia with its specific mechanism and management strategy.
METHODS: We reported three different TKI-induced IHA cases that occurred due to axitinib, sunitinib, and pazopanib, respectively. The first two cases were diagnosed with renal cell carcinoma and the last one was diagnosed with soft tissue sarcoma. They all presented with the characteristic symptoms of anemia and hemolysis. All the cases were detected positive for the complement C3d direct antiglobulin (direct coombs) test.
METHODS: Discontinuation of the causative drug and 1 mg/kg/day dose of corticosteroid treatment were able to control IHA in all three cases. Excluding the other factors of IHA and an evident laboratory and clinical benefit after withholding the TKI led to the diagnosis of TKI-related IHA in each case.
CONCLUSIONS: TKIs are relatively new in clinical practice and are being used for more indications and in more patients. To our knowledge#these three cases are unique in terms of axitinib#sunitinib#and pazopanib-related IHA.
METHODS: We reported three different TKI-induced IHA cases that occurred due to axitinib, sunitinib, and pazopanib, respectively. The first two cases were diagnosed with renal cell carcinoma and the last one was diagnosed with soft tissue sarcoma. They all presented with the characteristic symptoms of anemia and hemolysis. All the cases were detected positive for the complement C3d direct antiglobulin (direct coombs) test.
METHODS: Discontinuation of the causative drug and 1 mg/kg/day dose of corticosteroid treatment were able to control IHA in all three cases. Excluding the other factors of IHA and an evident laboratory and clinical benefit after withholding the TKI led to the diagnosis of TKI-related IHA in each case.
CONCLUSIONS: TKIs are relatively new in clinical practice and are being used for more indications and in more patients. To our knowledge#these three cases are unique in terms of axitinib#sunitinib#and pazopanib-related IHA.
摘要：
背景：分子多靶向小酪氨酸激酶抑制（TKI）药物，如阿西替尼，舒尼替尼和帕唑帕尼常用于几种类型的实体瘤。贫血不是这些药物的罕见作用，可能发生在所有级别。然而,药物诱导的免疫性溶血性贫血（IHA），一种非常罕见的疾病因其特定的机制和管理策略而不同于其他类型的贫血。
方法：我们报告了三例不同的TKI诱导的IHA病例，舒尼替尼,还有帕唑帕尼,分别。前两例诊断为肾细胞癌，最后一例诊断为软组织肉瘤。他们都表现为贫血和溶血的特征性症状。所有病例的补体C3d直接抗球蛋白（直接库姆斯）试验均为阳性。
方法：在所有3例病例中，停止致病药物和1mg/kg/天剂量的皮质类固醇治疗能够控制IHA。排除IHA的其他因素以及保留TKI后明显的实验室和临床益处导致在每种情况下诊断为TKI相关的IHA。
结论：TKIs在临床实践中相对较新，正被用于更多的适应症和更多的患者。据我们所知，这三个病例在阿西替尼#舒尼替尼#和帕唑帕尼相关的IHA方面是独特的。
方法：我们报告了三例不同的TKI诱导的IHA病例，舒尼替尼,还有帕唑帕尼,分别。前两例诊断为肾细胞癌，最后一例诊断为软组织肉瘤。他们都表现为贫血和溶血的特征性症状。所有病例的补体C3d直接抗球蛋白（直接库姆斯）试验均为阳性。
方法：在所有3例病例中，停止致病药物和1mg/kg/天剂量的皮质类固醇治疗能够控制IHA。排除IHA的其他因素以及保留TKI后明显的实验室和临床益处导致在每种情况下诊断为TKI相关的IHA。
结论：TKIs在临床实践中相对较新，正被用于更多的适应症和更多的患者。据我们所知，这三个病例在阿西替尼#舒尼替尼#和帕唑帕尼相关的IHA方面是独特的。
