Drug-Induced Immune Hemolytic Anemia Following Dapagliflozin Administration: A Case Report

Drug-induced immune hemolytic anemia (DIIHA) is an extremely rare and often undiagnosed cause of anemia. Due to variability in antibody type, binding affinity, and the presence or absence of the drug at the time of testing, serologic findings can be inconsistent, making diagnosis challenging and delaying treatment, which increases the risk of progression to organ failure or death. In this case report, we discuss a 52-year-old Caucasian male being treated for type 2 diabetes mellitus (T2DM) with dapagliflozin who developed jaundice and progressive fatigue after two weeks of treatment. He was found to have evidence of extravascular hemolysis with transaminitis, indirect hyperbilirubinemia, elevated LDH, and decreased haptoglobin. The patient was diagnosed with DIIHA likely due to dapagliflozin, and the medication was immediately discontinued from his regimen in the emergency department. He was stabilized after two transfusions of packed red blood cells (RBCs) and a short course of glucocorticoids. Here, we discuss the pathophysiology, workup, and management of DIIHA, a previously unreported adverse reaction to dapagliflozin, a drug commonly used to treat T2DM.