A Case of Immune Hemolytic Anemia Induced by Ceftizoxime and Cefobactam (Sulbactam/Cefoperazone).
10.3343/kjlm.2009.29.6.578
- Author:
Eun Jung BAEK
1
;
Sungsil LEE
;
Sinyoung KIM
;
Hyun Kyung CHOI
;
Hyun Ok KIM
Author Information
1. Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. hyunok1019@yuhs.ac
- Publication Type:Case Report
- Keywords:
Drug-induced immune hemolytic anemia;
Beta-lactamase inhibitor antibody;
Cephalosporin antibody;
Ceftizoxime antibody
- MeSH:
Anemia, Hemolytic/chemically induced/*diagnosis/immunology;
Anti-Bacterial Agents/*adverse effects;
Cefoperazone/*adverse effects;
Ceftizoxime/*adverse effects;
Erythrocytes/chemistry/metabolism;
Female;
Humans;
Middle Aged;
Sulbactam/*adverse effects
- From:The Korean Journal of Laboratory Medicine
2009;29(6):578-584
- CountryRepublic of Korea
- Language:English
-
Abstract:
Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
