Christie D J, Lennon S S, Drew R L, Swinehart C D
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis 55455.
Br J Haematol. 1988 Dec;70(4):423-6. doi: 10.1111/j.1365-2141.1988.tb02511.x.
Profound thrombocytopenia accompanied by a severe coagulopathy developed in an elderly female patient being treated with cefotetan while undergoing surgery for closure of a perforated gastric ulcer. During the acute phase of the bleeding diathesis, the patient had a platelet count of 12 x 10(9)/l, a prothrombin time of 88 s (normal 10.0-11.8 s) and a PTT of 105 s (normal 23.0-37.0 s). Potent IgG cefotetan-dependent anti-platelet antibodies, which also were weakly reactive with ampicillin, were detected in the patient's serum using immunofluorescence and a recently developed protein A-agarose rosette forming assay. Unlike typical cephalosporin- and penicillin-induced antibodies that react with cells pretreated with drug, this antibody only reacted with platelets in the presence of exogenous drug. Failure of the antibody to react with drug-coated platelets suggests the possibility that, in this patient, sensitization to cefotetan involved mechanisms other than formation of typical hapten-carrier complexes normally described for members of the cephalosporin family of antibiotics. This appears to be the first definitive report that cefotetan, or any other cephalosporin derivative, can induce immunologic thrombocytopenia.
一名老年女性患者在接受胃穿孔修补手术时接受头孢替坦治疗，出现了严重的血小板减少症并伴有严重的凝血病。在出血素质的急性期，患者血小板计数为12×10⁹/L，凝血酶原时间为88秒（正常为10.0 - 11.8秒），部分凝血活酶时间为105秒（正常为23.0 - 37.0秒）。使用免疫荧光和最近开发的蛋白A - 琼脂糖玫瑰花环形成试验在患者血清中检测到强效的IgG头孢替坦依赖性抗血小板抗体，该抗体与氨苄西林也有弱反应。与典型的头孢菌素和青霉素诱导的抗体不同，后者与用药物预处理的细胞反应，而这种抗体仅在存在外源性药物时才与血小板反应。该抗体与药物包被的血小板不反应，提示在该患者中，对头孢替坦的致敏涉及的机制可能不同于通常描述的头孢菌素类抗生素成员的典型半抗原 - 载体复合物形成机制。这似乎是关于头孢替坦或任何其他头孢菌素衍生物可诱导免疫性血小板减少症的第一份明确报告。
