Baek Eun Jung, Lee Sungsil, Kim Sinyoung, Choi Hyun Kyung, Kim Hyun Ok
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Lab Med. 2009 Dec;29(6):578-84. doi: 10.3343/kjlm.2009.29.6.578.
Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
多种药物同时引发的药物性免疫性溶血性贫血（DIIHA）较为罕见。我们报告一例由两种药物引起DIIHA的患者。患者血清在头孢唑肟或舒巴坦包被的红细胞（RBCs；通过药物吸附机制）以及存在舒巴坦时未包被的RBCs（通过免疫复合物机制）中均表现出凝集。尽管已知头孢唑肟通过免疫复合物方法会呈现阳性反应，无论是否与药物包被的RBCs发生反应，但该患者的抗体仅对药物包被的RBCs有反应。另一方面，已知通过非免疫性蛋白质吸附导致溶血性贫血的舒巴坦，在与药物包被的RBCs以及存在舒巴坦的检测中均呈现阳性反应。这是首例关于舒巴坦 - 头孢哌酮组合导致DIIHA的报告，也是第四例关于头孢唑肟导致DIIHA的报告。由于患者复杂的实验室检查结果，DIIHA仅在晚期才被怀疑。我们建议，为了快速诊断DIIHA，应通过两种方法对所有可能的致病药物进行检测。
