Drug-induced immune hemolytic anemia is a rare but underdiagnosed and potentially fatal condition. We report a case of severe hemolytic anemia induced by cefoxitin in a 45-year-old woman admitted with menometrorrhagia. Hemoglobin levels reached a nadir of 4.7 g/dl approximately 72 h after cefoxitin initiation, and hemolysis resolved when cefoxitin was discontinued and prednisone 1 mg/kg was initiated. A transfusion reaction workup revealed no abnormalities. Direct antiglobulin testing was weakly positive with anti-C3. The patient’s plasma and RBC eluate reacted with cefoxitin-treated RBCs but not with untreated RBCs in the presence or absence of cefoxitin.

Keywords:
Cephalosporin, Drug-induced hemolysis, Hemolytic anemia
1.
Petz LD, Garratty G: Immune Hemolytic Anemias, ed 2. Philadelphia, Churchill Livingstone, 2004, pp 261–317.
2.
Arndt PA, Leger RM, Garratty G: Serology of antibodies to second- and third-generation cephalosporins associated with immune hemolytic anemia and/or positive direct antiglobulin tests. Transfusion 1999;39:1239–1246.
3.
Garratty G: Drug-induced immune hemolytic anemia. Hematology Am Soc Hematol Educ Program 2009;73–79.
4.
Johnson ST, Fueger JT, Gottschall JL: One center’s experience: the serology and drugs associated with drug-induced immune hemolytic anemia – a new paradigm. Transfusion 2007;47:697–702.
5.
Arndt PA, Garratty G: The changing spectrum of drug-induced immune hemolytic anemia. Semin Hematol 2005;42:137–144.
6.
ACOG Practice Bulletin No. 104: Antibiotic Prophylaxis for Gynecologic Procedures. Obstet Gynecol 2009;113:1180–1189.
7.
Bratzler DW, Hunt DR: The Surgical Infection Prevention and Surgical Care Improvement Projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43:322–330.
8.
Merrill RM: Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 2008;14:CR24–CR31.
9.
Garratty G, Leger RM, Arndt PA: Severe immune hemolytic anemia associated with prophylactic use of cefotetan in obstetric and gynecologic procedures. Am J Obstet Gynecol 1999;181:103–104.
10.
DeTorres OH: Hemolytic anemia and pancytopenia induced by cefoxitin. Drug Intell Clin Pharm 1983;17:816–818.
11.
Toy E, Nesbitt R, Savastano G, Fox S, Araneta M, Hsueh Y: Warm autoantibody following plasma apheresis, complicated by acute intravascular hemolysis associated with cefoxitin-dependent antibody resulting in fatality. Transfusion 1980;29:51S.
12.
Habibi B: Drug induced red blood cell autoantibodies co-developed with drug specific antibodies causing haemolytic anaemias. Br J Haematol 1984;61:139–143.
13.
Viraraghavan R, Chakravarty AG, Soreth J: Cefotetan-induced haemolytic anaemia. A review of 85 cases. Adverse Drug React Toxicol Rev 2002;21:101–107.
14.
Mittendorf R, Aronson MP, Berry RE, Williams MA, Kupelnick B, Klickstein A, Herbst AL, Chalmers TC: Avoiding serious infections associated with abdominal hysterectomy: a meta-analysis of antibiotic prophylaxis. Am J Obstet Gynecol 1993;169:1119–1124.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.