Broadberry R E, Farren T W, Bevin S V, Kohler J A, Yates S, Skidmore I, Poole J, Garratty G
Transfusion Department, Southampton University Hospitals NHS Trust, Southampton, UK.
Transfus Med. 2004 Feb;14(1):53-7. doi: 10.1111/j.0958-7578.2004.00481.x.
A patient with pneumonia was treated with Tazocin (piperacillin/tazobactam). However, the expected haemoglobin (Hb) increment after transfusion was not achieved. Plasma bilirubin and lactate dehydrogenase were raised. The direct antiglobulin test (DAT) was positive (4+) for immunoglobulin G (IgG) only, but no RBC antibodies were demonstrable in the plasma or an eluate from the patient's RBCs. Drug-induced haemolysis was suspected. After discontinuing Tazocin administration, Hb and bilirubin levels returned to expected values. The patient's plasma gave a positive (3+) indirect antiglobulin reaction only with RBCs pretreated with tazobactam. However, random patient plasmas also gave weak (+/- to 1+) reactions, indicating non-immunological adsorption of IgG onto RBCs rather than specific anti-tazobactam antibodies. Subsequently, plasma samples with varying IgG levels (0.8-89.7 g L(-1)) were tested against RBCs pretreated with tazobactam. The amount of plasma IgG non-immunologically adsorbed onto the drug-coated RBCs was found to correlate directly with the plasma IgG level. The patient had a high plasma IgG level (41.6 g L(-1)) which explains why the antiglobulin test was stronger with the patient's plasma than with random plasma samples. Previous reports (Garratty & Arndt, (1998) British Journal of Haematology, 100, 777-783; Arndt & Garratty (2000) Transfusion, 40, 29S) suggested that non-immunological coating of RBCs with IgG may affect RBC survival; our results would support that suggestion. This is the first reported case of haemolytic anaemia associated with tazobactam.
一名肺炎患者接受了特治星（哌拉西林/他唑巴坦）治疗。然而，输血后预期的血红蛋白（Hb）升高并未实现。血浆胆红素和乳酸脱氢酶升高。直接抗球蛋白试验（DAT）仅对免疫球蛋白G（IgG）呈阳性（4+），但在血浆或患者红细胞洗脱液中未检测到红细胞抗体。怀疑是药物性溶血。停用特治星后，Hb和胆红素水平恢复到预期值。患者血浆仅与用他唑巴坦预处理的红细胞发生阳性（3+）间接抗球蛋白反应。然而，随机抽取的患者血浆也有弱阳性（+/-至1+）反应，表明IgG非免疫性吸附到红细胞上，而非特异性抗他唑巴坦抗体。随后，对不同IgG水平（0.8 - 89.7 g L⁻¹）的血浆样本进行了针对用他唑巴坦预处理的红细胞的检测。发现非免疫性吸附到药物包被红细胞上的血浆IgG量与血浆IgG水平直接相关。该患者血浆IgG水平较高（41.6 g L⁻¹），这解释了为什么患者血浆的抗球蛋白试验比随机血浆样本更强。先前的报告（Garratty & Arndt，（1998年）《英国血液学杂志》，100，777 - 783；Arndt & Garratty（2000年）《输血》，40，29S）表明，IgG对红细胞的非免疫性包被可能影响红细胞存活；我们的结果支持这一观点。这是首例报告的与他唑巴坦相关的溶血性贫血病例。
