Chambers L A, Donovan L M, Kruskall M S
Department of Pathology, Beth Israel Hospital, Boston, Massachusetts 02215.
Am J Clin Pathol. 1991 Mar;95(3):393-6. doi: 10.1093/ajcp/95.3.393.
A 35-year-old woman developed acute intravascular hemolysis within five days of beginning a course of ceftazidime. The direct antiglobulin test became strongly positive with both anti-IgG and anticomplement. The serum contained an antibody that, in the presence of ceftazidime, sensitized unmodified reagent cells with IgG and complement (immune-complex type). The serum also agglutinated ceftazidime-pretreated cells at room temperature and 37 degrees C (drug-adsorption type). Retrospective testing disclosed that the drug adsorption antibody, which had been present before the current course of antibiotics, was not demonstrable during the hemolysis. The reactivity of the immune complex antibody, which developed by the second day of ceftazidime, paralleled the degree of hemolysis and the strength of the direct antiglobulin test. The authors believe that this patient had two separate ceftazidime-dependent antibodies and that the antibody reactive by immune complex mechanism mediated an episode of acute intravascular hemolysis.
一名35岁女性在开始使用头孢他啶治疗的五天内发生了急性血管内溶血。直接抗球蛋白试验对抗IgG和抗补体均呈强阳性。血清中含有一种抗体，在头孢他啶存在的情况下，该抗体可使未修饰的试剂细胞被IgG和补体致敏（免疫复合物型）。血清在室温及37℃时也能凝集经头孢他啶预处理的细胞（药物吸附型）。回顾性检测发现，在本次抗生素治疗之前就已存在的药物吸附抗体在溶血期间无法检测到。在头孢他啶治疗第二天出现的免疫复合物抗体的反应性与溶血程度及直接抗球蛋白试验的强度平行。作者认为该患者有两种独立的头孢他啶依赖性抗体，且通过免疫复合物机制起反应的抗体介导了一次急性血管内溶血发作。
