The Relationship of Drug Therapy to Aplastic Anemia in Pakistan: A Hospital-Based Case Control Study

Muhammad Asif Syed,1 Aneela Atta Ur Rahman,2 Muhammad Nadeem Shah Syed,3 Naveed Masood Memon4 1Field Epidemiology & Laboratory Training Program (FELTP), Karachi, Pakistan; 2Department of Community Medicine & Public Health Sciences, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan; 3Federal NSTOP Officer, National Emergency Operation Center, Islamabad, Pakistan; 4Provincial Disease Surveillance and Response Unit, Hyderabad-Sindh, Field Epidemiology & Laboratory Training Program (FELTP), Karachi, PakistanCorrespondence: Muhammad Asif SyedField Epidemiology Laboratory Training Program (FELTP) Pakistan, Karachi, Sindh, PakistanTel +0092-286-34-77Email asif.mph@gmail.ccomIntroduction: Drug-induced aplastic anemia has long been a menacing outcome of modern pharmacotherapy. The incidence of idiosyncratic, drug-induced aplastic anemia varies depending on the genetic susceptibility and the associated drug. Only scarce studies have explained the epidemiology and actual incidence of this reaction.Purpose: The aim of the study was to establish the association between drugs and aplastic anemia.Methods: A case-control study was conducted with 191 cases and 696 controls at a tertiary hospital for blood diseases in Karachi-Pakistan. Cases were patients of aplastic anemia diagnosed through bone marrow biopsy. The controls did not have either AA or chronic diseases. Each case was paired with four sex and age group match controls. Cases and controls were compared with respect to the drugs used. Univariate and multivariate analysis were performed in order to delineate the association.Results: Median age of the study-participants was 27 years (04– 69 years). The majority 84 (44%) were from age group 16 to 30 years. The male-to-female ratio was 2:1. Among study participants, various drugs were significantly associated with aplastic anemia. Treatment of epilepsy with carbamazepine showed a positive association (OR=2.7, 95% C.I, 1.0– 6.8). An increased risk of aplastic anemia was noted with exposure to thiazide (OR=3.1, 95% C.I, 1.3– 7.4) and mebendazole (OR=3.7, 95% C.I, 1.5– 9.2). However, risks were not increased with chloramphenicol, trimethoprim/sulfamethoxazole, benzodiazepines, antihistamines, oral contraceptives, and herbal medicine.Conclusion: This large-scale case–control study provide association of aplastic anemia with exposure to carbamazepine, thiazides and mebendazole in population of Pakistan. Patients should be monitored with complete blood indices for early detection of drug toxicity.Keywords: drug induced aplastic anemia, case–control study, Karachi, Pakistan