Cephalothin-Induced Immune Hemolytic Anemia

Abstract

A patient with renal disease developed Coombs-positive hemolytic anemia while receiving cephalothin therapy. An anti-cephalothin IgG antibody was detected in the patient’s serum and in the eluates from her erythrocytes. In addition, nonimmunologic binding of normal and patient’s serum proteins to her own and cephalothin-coated normal red cells was demonstrated. Skin tests and in vitro lymphocyte stimulation revealed that the patient was sensitized to cephalothin and also to ampicillin. Careful investigation of drug-induced hemolytic anemias reveals the complexity of the immune mechanisms involved.

Drug-Induced Immune Hemolytic Anemia

“…[183][184][185][186] All five of these cases were associated with cephalothin (one of these cases was also associated with cefazolin). Only five well-documented cases due to first-generation cephalosporins were reported in a 25-year period.…”

Cephalosporin‐induced immune neutropenia

“…, and there are occasional reports of immune haemolytic anaemia (Kaplan et al, 1968;Nesmith & Davis, 1968;Gralnick et al, 1971;Forbes et al, 1972;Jeannet et al, 1976). There have been several reports of neutropenia associated with cephalosporins (Levin et al, 1971;Spath et al, 1972;Silber & Diokno, 1973;DiCato & Ellman, 1975;Mouallem, 1976;Galanaud et al, 1976;A110 & Silva, 1977;Homayouni et al, 1979;Rouveix et al, 1983), and one of thrombocytopenia (Gralnick et nl,19 72), but the mechanism of these cytopenias has been little studied.…”

Serology of antibodies to second‐ and third‐generation cephalosporins associated with immune hemolytic anemia and/or positive direct antiglobulin tests

“…First‐generation cepha‐ losporins (e.g., cephalothin, cephalexin, and cefazolin) have only rarely caused immune hemolytic anemia (IHA). Only five well‐documented cases 2–5 of IHA due to first‐generation cephalosporins have been reported since they were first used in the United States in 1964. All five cases were associated with cephalothin; one of these patients may have had additional problems associated with cefazolin 5 …”