MadSci Network: Medicine
Query:

Re: How common is 'drug-induced hemolytic anemia'

Date: Mon Aug 14 20:28:22 2000
Posted By: M. Salik Jahania, M.D., Suregry, Cardiothoracic, University of Kentucky
Area of science: Medicine
ID: 963547152.Me
Message:

Drug-induced hemolysis: cefotetan-dependent hemolytic anemia mimicking an 
acute intravascular immune transfusion reaction. 
AUTHORS:  Stroncek D; Procter JL; Johnson J 
AUTHOR AFFILIATION:  Department of Transfusion Medicine, Warren G. 
Magnuson Clinical Center, National Institutes of Health, Bethesda, 
Maryland 20892-1184, USA. 
SOURCE:  Am J Hematol 2000 May;64(1):67-70 
CITATION IDS:  PMID: 10815791 UI: 20273213 
ABSTRACT:  Numerous cases of drug-induced hemolytic anemia have been 
described in patients treated with penicillin or cephalosporin. Second and 
third generation cephalosporins are more commonly implicated in hemolytic 
reactions than first generation cephalosporins. We report a case of severe 
cefotetan-induced hemolytic anemia in a previously healthy 46-year-old 
woman undergoing an elective hysterectomy. The patient received 2 g of 
intravenous cefotetan intraoperatively and subsequently at 12 and 24 h 
post-operatively. She complained of diarrhea and fever on the third post-
operative day and was seen in her gynecologist's office on the fifth post-
operative day (hemoglobin = 10.5 g/dL). On the seventh post-operative day, 
she complained of fever and soreness around the suprapubic catheter site 
and was given a prescription for 500 mg oral cephalexin four times a day. 
The next day she was seen in the gynecologist's office and reported 
feeling better. Ten days after the operation her fatigue worsened and her 
hemoglobin was 4.8 g/dL. She was transfused with 3 units of packed red 
blood cells (PRBC) and was given 1 g of cefotetan intravenously. During 
the transfusion of the second unit of PRBC nursing staff observed gross 
hemoglobinuria and she subsequently developed acute renal failure. 
Laboratory chemistry parameters were consistent with severe acute 
hemolysis. The patient's direct antiglobulin test was reactive and her 
serum reacted with cefotetan-coated red blood cells (RBCs) and serum plus 
soluble cefotetan reacted with untreated RBCs. The titration endpoint of 
the serum against cefotetan-coated RBCs was 40,960, while the serum plus 
soluble cefotetan against uncoated RBCs was 2,560. This case of severe 
cefotetan-induced hemolysis was complicated by an acute hemolytic event 
that occurred during the transfusion of PRBC. Clinical and transfusion 
service staff must consider drug-induced hemolysis in the differential 
diagnosis of acute anemia. 



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