American Red Cross Blood Services, Southern California Region, Pomona, California 91768, USA.
Transfusion. 2012 Mar;52(3):602-12. doi: 10.1111/j.1537-2995.2011.03321.x. Epub 2011 Aug 31.
Ceftriaxone, a third-generation cephalosporin, is commonly used to prevent and treat infections. Since 1987, it has been the second most common cause of drug-induced immune hemolytic anemia (DIIHA) investigated in our laboratory.
Samples from 79 patients (1987-2010), suspected of having DIIHA caused by ceftriaxone, were studied for the presence of ceftriaxone antibodies. Direct antiglobulin tests (DATs) and tests with ceftriaxone-treated red blood cells (RBCs) or untreated and enzyme-treated RBCs in the presence of ceftriaxone were performed.
Twenty-five (32%) of the 79 patients had antibodies to ceftriaxone detected. Seventeen (68%) of the 25 patients were children; reactions in children were usually dramatic and severe. Nine (36%) of the 25 patients had fatal DIIHA. Nineteen of the 25 samples had DATs performed by our laboratory; 100% of samples were reactive with anti-C3 and 47% were reactive with anti-IgG. All 25 sera had ceftriaxone antibodies detected when testing untreated or ficin-treated RBCs in the presence of ceftriaxone (resulting in agglutination, hemolysis or sensitization of test RBCs). These antibodies were primarily IgM and reactivity was enhanced by testing ficin-treated RBCs. Sixteen (64%) of the 25 sera reacted with test RBCs when no ceftriaxone was added in vitro; this was most likely due to the transient presence of drug or drug-immune complexes in the patient's circulation at the time that the blood samples were drawn.
Ceftriaxone antibodies can cause severe intravascular hemolysis. Complement can usually be detected on the patient's RBCs and IgM antibodies are usually detected in the patient's serum.
头孢曲松是一种第三代头孢菌素，常用于预防和治疗感染。自 1987 年以来，它一直是我们实验室调查的第二大常见的药物诱导免疫性溶血性贫血（DIIHA）原因。
研究了 79 例（1987-2010 年）疑似头孢曲松引起的 DIIHA 患者的样本，以检测头孢曲松抗体。进行了直接抗球蛋白试验（DAT）和用头孢曲松处理的红细胞（RBC）或未经处理和酶处理的 RBC 在头孢曲松存在下的测试。
79 例患者中有 25 例（32%）检测到头孢曲松抗体。25 例患者中有 17 例（68%）为儿童；儿童的反应通常很剧烈和严重。25 例患者中有 9 例（36%）发生致命的 DIIHA。25 例样本中有 19 例由我们实验室进行 DAT 检测；100%的样本与抗 C3 反应，47%与抗 IgG 反应。当在头孢曲松存在下检测未经处理或ficin 处理的 RBC 时，所有 25 例血清均检测到头孢曲松抗体（导致测试 RBC 聚集、溶血或致敏）。这些抗体主要是 IgM，ficin 处理的 RBC 检测可增强反应性。在体外未添加头孢曲松时，25 例血清中有 16 例（64%）与测试 RBC 反应；这很可能是由于在采集血液样本时患者循环中短暂存在药物或药物免疫复合物。
头孢曲松抗体可引起严重的血管内溶血。患者的 RBC 上通常可检测到补体，患者的血清中通常可检测到 IgM 抗体。
