Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Department of Pathogeny Biology, Basic Medicine College, Qingdao University, Qingdao, Shandong, China.
Department of Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, Shandong, China.
Transfus Apher Sci. 2022 Apr;61(2):103324. doi: 10.1016/j.transci.2021.103324. Epub 2021 Nov 23.
Piperacillin antibody-induced immune hemolytic anemia is not rare in adults, and there have been reports of anti-HLA antibody-induced newborn platelet transfusion refractoriness. However, there has been no report of piperacillin-accompanied anti-HLA antibody-induced newborn pancytopenia.
We herein present the case of a newborn with pancytopenia from a mother who carried anti-HLA-B55, anti-HLA-DR11, and piperacillin antibodies. The newborn HLA genotypes were HLAB55:02 and HLADRB1*11:01. IgG antibodies can be transferred to the newborn via the placenta and induce the destruction of the platelet and white blood cells, which carry the corresponding antigens. Piperacillin antibodies coupling with newborn red blood cells (RBCs) led to the destruction of the RBCs and hemolytic anemia.
The direct anti-globulin test was positive for RBCs in the newborn, and piperacillin antibodies were positive in both the newborn and his mother. Anti-HLA antibodies were positive in the maternal serum, whereas homologous antigens were positive in the newborn. The direct anti-globulin test of platelet was weekly positive in the newborn.
Piperacillin and anti-HLA antibodies can pass through the placenta, induce incompatible blood cell destruction, and cause a series of clinical syndromes in newborns.
哌拉西林抗体引起的免疫性溶血性贫血在成人中并不罕见，并且已有抗 HLA 抗体引起新生儿血小板输注无效的报道。然而，尚无哌拉西林伴随抗 HLA 抗体引起新生儿全血细胞减少症的报道。
我们在此介绍一例因母亲携带哌拉西林抗体、抗 HLA-B55、抗 HLA-DR11 而导致新生儿全血细胞减少症的病例。新生儿 HLA 基因型为 HLAB55：02 和 HLADRB1*11：01。IgG 抗体可通过胎盘转移至新生儿，并导致携带相应抗原的血小板和白细胞被破坏。哌拉西林抗体与新生儿红细胞（RBC）结合导致 RBC 破坏和溶血性贫血。
新生儿 RBC 的直接抗球蛋白试验呈阳性，且新生儿及其母亲的哌拉西林抗体均呈阳性。母体血清中存在抗 HLA 抗体，而新生儿存在同源抗原。新生儿血小板的直接抗球蛋白试验每周均呈阳性。
哌拉西林和抗 HLA 抗体可通过胎盘，诱导不相容血细胞破坏，并导致新生儿出现一系列临床综合征。
