Seltsam A, Salama A
Department of Internal Medicine, Charité University Hospital/Virchow Clinic, Humboldt University, Berlin, Germany.
Intensive Care Med. 2000 Sep;26(9):1390-4. doi: 10.1007/s001340000598.
In this report, we will describe the occurrence of intravascular immune haemolytic anaemia (IHA) associated with ceftriaxone and/or its metabolites in two of our patients. Serological examinations were carried out to demonstrate and characterise the causative antibodies. The findings of all previously reported cases will also be discussed.
Direct antiglobulin tests (DAT) and indirect antiglobulin tests were performed according to standard procedures. Tests for drug-dependent antibodies were performed in the presence and absence of the target drugs and their ex vivo antigens (in the urine of patients treated with the drugs).
Ceftriaxone-related haemolysis resulted in the death of one of our patients (patient 2), and caused acute renal failure in the other (patient 1). The DATwas strongly positive for anti-C3d and anti-IgG in one case (patient 2), and for anti-C3d alone in the other (patient 1). The serum of patient 1 reacted with red blood cells only in the presence of ex vivo antigens, while that of patient 2 reacted positively to native ceftriaxone and its ex vivo antigen. In the latter patient, the antibodies appeared to cross-react with native cefotaxime whereas, in the first patient, they weakly cross-reacted only with the ex vivo antigens of cefotaxime and cefpodoxime proxetil.
Ceftriaxone and/or its trace metabolites may induce life-threatening IHA in children and adults. Serological work-up must include tests to determine the cross-reactivity of ceftriaxone-dependent antibodies to avoid immune haemolysis due to administration of structurally related cephalosporins in affected patients.
在本报告中，我们将描述在我们的两名患者中发生的与头孢曲松及其代谢产物相关的血管内免疫性溶血性贫血（IHA）。进行了血清学检查以证实并鉴定致病抗体。还将讨论所有先前报道病例的研究结果。
按照标准程序进行直接抗球蛋白试验（DAT）和间接抗球蛋白试验。在有和没有目标药物及其体外抗原（在接受该药物治疗的患者尿液中）的情况下进行药物依赖性抗体检测。
头孢曲松相关的溶血导致我们的一名患者（患者2）死亡，另一名患者（患者1）出现急性肾衰竭。在一个病例（患者2）中，DAT抗C3d和抗IgG呈强阳性，在另一个病例（患者1）中仅抗C3d呈阳性。患者1的血清仅在存在体外抗原时与红细胞发生反应，而患者2的血清对天然头孢曲松及其体外抗原呈阳性反应。在后一名患者中，抗体似乎与天然头孢噻肟发生交叉反应，而在第一名患者中，它们仅与头孢噻肟和头孢泊肟酯的体外抗原发生弱交叉反应。
头孢曲松及其微量代谢产物可能在儿童和成人中诱发危及生命的IHA。血清学检查必须包括检测头孢曲松依赖性抗体的交叉反应性，以避免在受影响的患者中因使用结构相关的头孢菌素而导致免疫溶血。
