Some drugs (such as sulfonamides, phenothiazines, quinidine, and quinine) can cause an immune hemolytic anemia even though they do not bind to RBCs. These drugs, bound to plasma proteins, stimulate the formation of complement-fixing antibodies that activate the classical complement pathway. Generated C3b binds to the RBC, which leads to intravascular hemolysis of these”innocent bystanders“.

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