sulfasalazine and organic antimony. It may be that in some of these cases a drug-protein-antigen/antibody interaction involves erythrocytes casually, i.e. a true 'innocent bystander' phenomenon.
• Dose-related pharmacodynamic action on normal cells e.g. lead, benzene, phenylhydrazine, chlorates (weed-killer), methyl chloride (refrigerant), some snake venoms.
• Idiosyncrasy (see Pharmacogenetics). Precipitation of a haemolytic crisis may also occur with the above drugs in the rare genetic haemoglobinopathies. Treatment is to withdraw the drug, and an adrenal steroid is useful in severe cases if the mechanism is immunological. Blood transfusion may be needed.
7. Fever is common; a mechanism is the release of interleukin-1 by leucocytes into the circulation which acts on receptors in the hypothalamic thermoregulatory centre, releasing prostaglandin Er
8. Collagen diseases (type II) and syndromes resembling them, e.g. systemic lupus erythematosus are sometimes caused by drugs, e.g. hydralazine, procainamide, isoniazid, sulphonamides. Adrenal steroid is useful.
9. Hepatitis and cholestatic jaundice are sometimes allergic (type II, see Drugs and the Liver). Adrenal steroid may be useful.
10. Nephropathy of various kinds (types II, III) occurs as does damage to other organs, e.g. myocarditis. Adrenal steroid may be useful.
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