University Children's Hospital, University of Würzburg, Josef-Schneider Str. 2, 97080 Würzburg, Germany.
Infection. 2010 Apr;38(2):131-4. doi: 10.1007/s15010-009-9227-8. Epub 2010 Mar 5.
We report a 23-year-old female patient with cystic fibrosis developing severe intravascular hemolysis with a minimal hemoglobin level of 1.6 g/dl after 7 days of treatment with piperacillin, consistent with an immune-mediated hemolytic crisis. Twenty days later, the patient could leave the hospital in good condition without any neurological deficit. To our knowledge, this is the lowest reported hemoglobin value caused by hemolytic anemia with intact survival. As piperacillin is commonly used in patients with cystic fibrosis, it is important to monitor the full-blood counts of patients during treatment with piperacillin and to be aware of the potential for hemolytic anemia to develop. Anti-piperacillin antibodies should be considered whenever these patients develop hemolytic anemia or a positive direct antiglobulin test (DAT). Furthermore, drug-fever under piperacillin application could be a warning sign for the development of hemolytic anemia.
我们报告了一例 23 岁女性囊性纤维化患者，在接受哌拉西林治疗 7 天后出现严重血管内溶血性贫血，血红蛋白最低值为 1.6 g/dl，符合免疫介导的溶血性危象。20 天后，患者病情良好出院，无任何神经功能缺损。据我们所知，这是报道的因溶血性贫血导致的血红蛋白值最低且存活完整的病例。由于哌拉西林在囊性纤维化患者中广泛使用，在使用哌拉西林治疗期间监测患者的全血细胞计数并了解溶血性贫血发生的可能性非常重要。如果这些患者出现溶血性贫血或直接抗球蛋白试验（DAT）阳性，应考虑抗哌拉西林抗体。此外，哌拉西林应用下的药物热可能是溶血性贫血发展的警告信号。
