Piperacillin-Induced Immune Hemolytic Anemia in an Adult with Cystic Fibrosis

Abstract

We report a case of drug-induced immune hemolytic anemia (DIIHA) in an adult female with cystic fibrosis (CF), complicating routine treatment of a pulmonary exacerbation with intravenous piperacillin-tazobactam. Workup revealed a positive direct antiglobulin test (DAT) due to red blood cell (RBC)-bound IgG and C3 and piperacillin antibodies detectable in the patient's serum. The potential influence of CF transmembrane conductance regulator mutations on the severity of DIIHA is discussed. This report illustrates the importance of early identification of DIIHA, a rare complication of a commonly utilized medication in CF.

Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest

“…There are two striking similarities between our patient and several published cases: prior piperacillin treatment on multiple occasions and latency between piperacillin initiation and development of anemia [1–10]. We hypothesize that repeated piperacillin treatment may predispose to PIHA by providing multiple opportunities for hapten-antigen challenge and the activation of immune hemolysis.…”

Drug‐induced immune hemolytic anemia associated with anti‐carboplatin and the first example of anti‐paclitaxel

“…The reactivity observed with the plasma collected shortly after the chemotherapy with the paclitaxel‐treated and untreated RBCs was most likely due to carboplatin, paclitaxel, or both drugs still present in the patient's circulation at the time the sample was collected, not due to autoantibody. We and others have reported this phenomenon . The eluate was nonreactive with saline‐suspended drug‐treated and untreated RBCs.…”

Life-threatening piperacillin-induced immune haemolysis in a patient with cystic fibrosis

“…Thought to be a result of the CFTR (cystic fibrosis transmembrane regulator) gene, this ultimately leads to decreased nitrous oxide production. The resulting impairment in vasodilatation combined with haemolytic anaemia may be one reason why patients with cystic fibrosis are prone to severe, life-threatening DIHHA as compared with the general population 6 7…”