Cefoperazone/sulbactam-induced hemolytic anemia

Abstract

Drug-induced hemolytic anemia (DIHA) is a rare complication of drug therapy and usually underdiagnosed. Cefoperazone/sulbactam is a compound prepared from the third generation of cephalosporin and β-lactamase inhibitor. There are limited data of DIHA induced from cefoperazone/sulbactam. A 93-year-old female patient, who had an operation on the biliary tract 3 months ago, was admitted to our hospital with an abdominal infection. After cefoperazone/sulbactam was given as anti-infection treatment, the patient developed hemolytic anemia on the third day. Cefoperazone/sulbactam was discontinued and replaced with meropenem. Subsequently the level of red blood cells, hemoglobin, and hematocrit returned to normal. Clinicians should pay attention to monitoring the possible adverse reactions during the use of cefoperazone/sulbactam and should be aware of the occurrence of DIHA, so as to give timely treatment.

Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

“…In some instances, the antibody that is detected appears to be an autoantibody resembling autoantibodies found in wAIHA [16,26,38,111]. In this case, the DAT is positive for IgG without apparent drug-dependence and with IgG antibody detectable in the patient's plasma [16].…”

“…Drug-induced immune hemolytic anemia (DIIHA) is a rare condition primarily caused by the existence of drug-induced antibodies, which may be classified as either drugdependent or drug-independent [16,38,[109][110][111]. Patients with DIIHA may have signs of the rapid destruction of red blood cells inside blood vessels quickly after receiving the medicine.…”

“…Patients with DIIHA may have signs of the rapid destruction of red blood cells inside blood vessels quickly after receiving the medicine. This may be seen, for example, in babies who develop hemolytic anemia because of ceftriaxone therapy [110,111]. In contrast, some people may have less severe signs of extravascular hemolysis, which might occur many months after therapy, as shown in instances of methyldopa-induced hemolytic anemia [26,38].…”

“…Alternatively, a drug may complex with the RBC in vivo forming a compound antigen, a neoantigen, that requires the drug to be in the testing system to detect its activity [38]. Examples of this mechanism include secondand third-generation cephalosporins such as cefotetan and ceftriaxone [38,110,111].…”

“…Methyldopa is rarely used anymore. Currently, drugs that can result in the production of an IgG autoantibody to the patient's RBCs include cefotetan and ceftriaxone [38,111]. These drugs also act by both hapten-specific and neoantigendependent mechanisms, making these two drugs potentially dangerous [110,111].…”