Creighton University School of Medicine, Omaha, NE, USA.
Department of Internal Medicine, Creighton University, Omaha, NE, USA.
Eur J Med Res. 2021 Nov 24;26(1):133. doi: 10.1186/s40001-021-00604-9.
Cefazolin is a first-generation cephalosporin commonly used for skin and soft tissue infections, abdominal and orthopedic surgery prophylaxis, and methicillin-sensitive staph aureus. Cephalosporins as a whole are known potential inducers of hemolytic anemia; however, mechanism of action is primarily autoimmune, and compared to other drugs, cefazolin is the least common.
A rare case report of cefazolin-induced hemolytic anemia "CIHA" and a systematic review of CIHA articles in English literature. Two authors performed review of publications and articles were selected based on inclusion and exclusion criteria. A systematic search of the literature yielded 768 entries with five case reports on cefazolin-induced hemolytic anemia.
CASE PRESENTATION/RESULTS: An 80-year-old female with methicillin-sensitive Staphylococcus aureus "MSSA" endocarditis. The patient was started on intravenous "IV" cefazolin that that resulted in hemolytic anemia and eosinophilia. Switching to vancomycin improved hemoglobin level and resolved eosinophilia. Four cefazolin-induced hemolytic anemia case reports and one population-based article with a case reported were analyzed with respect to direct antiglobulin test "DAT" (also known as the direct Coombs test) results, prior penicillin sensitivity, and acute anemia causes exclusion.
CIHA is a rare cause of clinically significant anemia. The diagnosis of drug-induced anemia is one of exclusion. It is important to consider DAT results and prior penicillin sensitivity when evaluating a patient for cefazolin-induced hemolytic anemia. However, the frequency of cefazolin use and resultant anemia necessitates early recognition of hemolytic anemia and prompt discontinuation of cefazolin, especially with long-term use.
头孢唑林是一种常用于治疗皮肤和软组织感染、腹部和骨科手术预防以及甲氧西林敏感金黄色葡萄球菌感染的第一代头孢菌素。总的来说，头孢菌素类药物是潜在的溶血性贫血诱导剂；然而，其作用机制主要是自身免疫性的，与其他药物相比，头孢唑林的发生率最低。
我们报告了一例头孢唑林诱导的溶血性贫血（CIHA）的罕见病例，并对英语文献中关于 CIHA 的文章进行了系统回顾。两名作者对出版物进行了回顾，根据纳入和排除标准选择了文章。对文献进行系统搜索，得到了 768 项研究结果，其中有 5 篇关于头孢唑林诱导的溶血性贫血的病例报告。
病例介绍/结果：一名 80 岁女性患有甲氧西林敏感金黄色葡萄球菌（MSSA）心内膜炎。患者开始接受静脉注射头孢唑林治疗，随后出现溶血性贫血和嗜酸性粒细胞增多。改用万古霉素后，血红蛋白水平得到改善，嗜酸性粒细胞增多得到缓解。我们分析了 4 例头孢唑林诱导的溶血性贫血病例报告和 1 例基于人群的病例报告，涉及直接抗球蛋白试验（DAT）（也称为直接 Coombs 试验）结果、青霉素过敏史和急性贫血原因排除。
CIHA 是一种罕见的引起临床显著贫血的原因。药物性贫血的诊断需要排除其他原因。在评估患者是否发生头孢唑林诱导的溶血性贫血时，考虑 DAT 结果和青霉素过敏史非常重要。然而，头孢唑林的使用频率和由此导致的贫血需要及早识别并及时停用头孢唑林，尤其是在长期使用时。
