Munizza M, Kavitsky D, Schainker B A, Poyser A, Peek C, Nance S
American Red Cross Blood Services, Penn-Jersey Region, and Frankford Hospital, Philadelphia, Pennsylvania.
Transfusion. 1993 Aug;33(8):689-92. doi: 10.1046/j.1537-2995.1993.33893342754.x.
A 49-year-old woman presented with a hemoglobin level of 9.5 g per dL (95 g/L), reticulocyte count of 6.7 percent (0.067), and hemoglobinuria. The next day, the hemoglobin had dropped to 5.8 g per dL (58 g/L), and total bilirubin was 8.8 mg per dL (150 mumol/L). The serum reacted 2+ with all red cells (RBCs). The direct antiglobulin test (DAT) was 3+ with anti-IgG and 1+ with anti-C3, but eluates prepared by two different methods did not react with untreated RBCs. The eluate reacted 2+ with amoxicillin-coated RBCs; amoxicillin had been listed in the patient's record as a previous medication. The patient denied recent ingestion of amoxicillin. Further investigation documented the injection of a dye, fluorescein sodium (AK-FLUOR-25%), for a ophthalmologic fluorescein angiographic study 2 days before admission. RBCs coated with AK-FLUOR reacted with the eluate. Controls consisting of normal serum, an eluate prepared from DAT-negative RBCs, and a serum known to contain anti-penicillin did not react with AK-FLUOR-coated RBCs. Nine days later, the DAT was negative and the serum did not react with untreated RBCs. In the presence of AK-FLUOR (1-in-125) or amoxicillin (1 mg/mL), the serum reacted 2+ in the antiglobulin test. Antibodies to AK-FLUOR and amoxicillin appeared to react by two mechanisms, which is similar to results in recent reports of other drugs associated with hemolytic anemia. AK-FLUOR has not previously been reported to be associated with hemolytic anemia.
一名49岁女性，血红蛋白水平为9.5克/分升（95克/升），网织红细胞计数为6.7%（0.067），并出现血红蛋白尿。次日，血红蛋白降至5.8克/分升（58克/升），总胆红素为8.8毫克/分升（150微摩尔/升）。血清与所有红细胞（RBC）反应呈2+。直接抗球蛋白试验（DAT）与抗IgG反应为3+，与抗C3反应为1+，但通过两种不同方法制备的洗脱液与未处理的RBC不发生反应。洗脱液与阿莫西林包被的RBC反应呈2+；患者病历中曾记录使用过阿莫西林。患者否认近期服用过阿莫西林。进一步调查发现，入院前2天患者因眼科荧光素血管造影检查注射了一种染料，荧光素钠（AK-FLUOR-25%）。AK-FLUOR包被的RBC与洗脱液发生反应。由正常血清、从DAT阴性RBC制备的洗脱液以及已知含有抗青霉素的血清组成的对照，与AK-FLUOR包被的RBC不发生反应。九天后，DAT为阴性，血清与未处理的RBC不发生反应。在存在AK-FLUOR（1:125）或阿莫西林（1毫克/毫升）的情况下，血清在抗球蛋白试验中反应呈2+。针对AK-FLUOR和阿莫西林的抗体似乎通过两种机制发生反应，这与近期其他与溶血性贫血相关药物的报道结果相似。此前尚未有AK-FLUOR与溶血性贫血相关的报道。
