头孢替坦通过药物吸附机制诱发的免疫性溶血性贫血。

Eckrich R J, Fox S, Mallory D

American Red Cross Blood Services, National Reference Laboratory for Blood Group Semlogy, 15601 Grabbs Branch Way, Rockville, MD 20855, USA.

Immunohematology. 1994;10(2):51-4.

Positive direct antiglobulin tests (DATs) associated with cephalosporin therapy have been reported, but rarely were associated with immune hemolytic anemia (IHA). In 1989, we described the first case of IHA associated with cefotetan (Cefotantrade mark) causing hemolysis by the drug-adsorption mechanism. We now report the full details of ow investigation. The patient was a 23-year-old female with a 2 1/2 year history of chronic ulcerative colitis. After 4 days of therapy with cefotetan (2 g/day), her hematocrit (Hct) decreased from 34.351 to 23.3%. The reticulocyte count was 6.9%. The DAT was 2+ (IgG only), and the serum and an eluate were nonreactive with a panel of standard reagent red blood cells (RBCs). Cefotetan therapy continued and the patient was transfused with two units of RBCs. On day 6 of therapy, the patient experienced an anaphylactoid reaction attributed to sensitivity to cefotetan. Cefotetan therapy was discontinued, the patient was treated with corticosteroids and epinephrine, and she was transfused with an additional unit of RBCs. Her Hct rose to 34.1% prior to her discharge on day 11. Further investigation revealed that the patient's serum and an eluate contained an antibody that reacted with cefotetan- and cephalothin-coated RBCs by the indirect antiglobulin test. In a monocyte monolayer assay, monocytes readily phagocytized cefotetan- and cephalothin-coated reagent RBCs but not uncoated reagent RBCs. The patient's serum did not react by the so-called immune-complex mechanism when cefotetan or cephalothin was added to the patient's serum + complement + RBCs.

已有报道称头孢菌素治疗会出现直接抗球蛋白试验（DAT）阳性，但很少与免疫性溶血性贫血（IHA）相关。1989年，我们描述了首例与头孢替坦（商品名Cefotantrade mark）相关的IHA病例，其通过药物吸附机制导致溶血。我们现在报告我们调查的全部细节。患者为一名23岁女性，有2年半的慢性溃疡性结肠炎病史。在用头孢替坦（2g/天）治疗4天后，她的血细胞比容（Hct）从34.3%降至23.3%。网织红细胞计数为6.9%。DAT为2+（仅IgG），血清和洗脱液与一组标准试剂红细胞（RBC）无反应。继续使用头孢替坦治疗，并给患者输注了两单位RBC。在治疗第6天，患者出现了归因于对头孢替坦敏感的类过敏反应。停用头孢替坦治疗，患者接受了皮质类固醇和肾上腺素治疗，并额外输注了一单位RBC。在第11天出院前，她的Hct升至34.1%。进一步调查发现，患者的血清和洗脱液中含有一种抗体，通过间接抗球蛋白试验，该抗体可与头孢替坦和头孢噻吩包被的RBC发生反应。在单核细胞单层试验中，单核细胞很容易吞噬头孢替坦和头孢噻吩包被的试剂RBC，但不吞噬未包被的试剂RBC。当将头孢替坦或头孢噻吩加入患者血清+补体+RBC中时，患者血清未通过所谓的免疫复合物机制发生反应。