A case of immune hemolytic anemia induced by ceftizoxime and cefobactam (sulbactam/cefoperazone)

Korean J Lab Med. 2009 Dec;29(6):578-84. doi: 10.3343/kjlm.2009.29.6.578.

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.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Hemolytic / chemically induced
  • Anemia, Hemolytic / diagnosis*
  • Anemia, Hemolytic / immunology
  • Anti-Bacterial Agents / adverse effects*
  • Cefoperazone / adverse effects*
  • Ceftizoxime / adverse effects*
  • Erythrocytes / chemistry
  • Erythrocytes / metabolism
  • Female
  • Humans
  • Middle Aged
  • Sulbactam / adverse effects*

Substances

  • Anti-Bacterial Agents
  • Cefoperazone
  • Ceftizoxime
  • Sulbactam