CHM as a trigger for autoimmune hemolytic anemia?

November 13, 2009

Hi All,

One case of autoimmune hemolytic anemia was associated with a

TCM formula [Wei'ande]. See abstract below.

From the herbs listed in the formula (below), which one(s) can cause

haemolysis?

http://tinyurl.com/yhn9blq + http://tinyurl.com/yzadrof say:

Weide'an Pian / Weide'an Jiaonang ST-

Calming Tabs / Med Caps: Baizhu, Banxia (Jiang), Binglang,

Cangzhu, Caodoukou, Chenpi (Zhi ), Chuanxiong, Fuling, Gancao,

Ganjiang, Gualou, Haipiaoxiao, Houpo, Huangbai, Huangqin, Laifuzi,

Maiya, Malancao , MUXIANG, Shanjiangzi

(Alpinia), Shenqu, Xiangfu (Zhi ), Zexie, Zhishi (Luyi) (

), Ziheche;

Dose: 5 X 475mg Tabs TID-QID (total 7.1-9.5g Extract / d) / 2-3 X

550mg Caps TID-QID (total 3.3-6.6g Extract / d); take fasting w

warm water;

Actions: Tone SP; Digestive; Aid ST Fx; Harmonise ST + Anodyne

; Move Food Stag;

Uses: ST pain ; ST hyperacidity ; gastritis~ chronic,

ST ulcer, duodenum ulcer;

CI in Xu children & elderly cases; CAUTION / CI in pregnancy;

AVOID in ST pain~ severe, emesis, melaena; AVOID spicy food; use

w medical approval in ST pain~ acute / in ST ulcer~ active; consult

hospital if not improved in 3d

Borneol / Camphor / Napthalenes were not mentioned in the formula.

I cannot see any obvious candidate there to cause haemolysis. Can

you?

Borneol / Camphor / napthalenes can cause haemolysis. See:

http://tinyurl.com/yf4buvg.

Do you use Borneol or Camphor in your formulas for oral use? Any

problemst?

Shen Y (2009) Autoimmune hemolytic anemia associated w a

formulation of traditional Chinese medicines. Am J Health Syst

Pharm. 2009 Oct 1;66(19):1701-3. Dept of Hematology, Second

Hospital of Shantou University Medical College, No. 22 Xinling

Road, Shantou City 515041, China. shenyoujin

PURPOSE: A case of autoimmune hemolytic anemia (AIHA) after

treatment w a CHM preparation is reported. SUMMARY: A 29-year-

old woman was admitted to the hospital w the primary complaints of

icterus, tea-colored urine, & fatigue lasting 10 days. 13 days prior, she

went to a local private clinic seeking treatment for mild stomach pain

& general malaise & was given Weide'an Pian. She took 4 tablets of

Weide'an, a Chinese herbal preparation, orally TID for 2 days. After 2

days, she experienced fatigue, dizziness, & chest distress &

subsequently discontinued treatment. On examination, she exhibited

mild scleral & mucosal icterus. Her conjunctivas were pale, & her

skin was slightly icterusd. Preliminary laboratory tests found a low

hemoglobin level & an elevated reticulocyte count. Biochemical tests

showed an elevated total serum bilirubin concentration w indirect

hyperbilirubinemia. Coombs' test results were positive for IgG but

negative for C3. All other test results were normal. She was

diagnosed w AIHA secondary to Weide'an use, & she was treated

promptly w oral prednisone, i.v. cimetidine, & oral sodium

bicarbonate tablets. 7 days later, she showed clinical improvement.

Her hemoglobin level rapidly increased to above 100 g/L, w a

corresponding decrease in her reticulocyte count & serum bilirubin

value over the next 8 days. She was discharged 15 days after

admission & was asymptomatic at a three-week follow-up visit.

CONCLUSION: Weide'an FORMULA was associated w AIHA in a

woman taking the remedy for gastritis. PMID: 19767374 [PubMed -

indexed for MEDLINE]

Best regards,

November 13, 2009

It would be interesting to know if she was on any concurrant medications or if

the formula was tested for pharm adulterants. Of course the Borneal is a bit

iffy internally. Also no mention of any other past medical history or chronic

disorders that may have made her more likely to have adverse event. Oh well, I'm

sure it will show up sometime in the future as herbs are bad and chinese herbs

are dangerous.

Be well,

Bob

Robert Linde, AP, RH

Professional Herbalists Training Program

Acupuncture & Herbal Therapies

901 Central Ave

St. Petersburg, FL 33705