A Rapidly Fatal Case of Immune Haemolytic Anaemia due to Cefotetan

Peano, Gian Michele; Menardi, Giuseppe; Quaranta, Luigi; Abello, Paola; Landra, Marino; Fenoglio, S.

doi:10.1111/j.1423-0410.1994.tb00285.x

Cited by 10 publications

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“…There have been 49 reports 4,6–13,16–21 (also Perkins J, Clay L., Written communication, January 197) since 1985 of immune hemolysis related to second‐ and third‐generation cephalosporins. Even when one considers that there are almost certainly a number of unreported cases, the incidence of this complication is very low relative to the number of doses of these drugs dispensed worldwide each year.…”

Section: Discussionmentioning

confidence: 99%

“…Even when one considers that there are almost certainly a number of unreported cases, the incidence of this complication is very low relative to the number of doses of these drugs dispensed worldwide each year. Of importance, however, is the high proportion of patients within the reported group (16 of 49) who had a fatal outcome directly related to the hemolytic anemia 4,6–13 (also Perkins J, Clay L., Written communication, January 1997). Two patients 4,18 died of other causes following recovery from hemolysis.…”

Section: Discussionmentioning

confidence: 99%

“…Two patients 4,18 died of other causes following recovery from hemolysis. Other features of interest are the female preponderance revealed when sex is indicated (19 females, 7 males), the broad age range among 26 reports giving this information (2‐77 years, but only five pediatric patients ages 2 to 14 9–13 ), the high proportion of cefotetan‐related cases (31 of 49) 4,6–8,22, (also Perkins J, Clay L., Written communication, January 1997) and the frequent association of cefotetan (nine of the 31 reported cases) and ceftriaxone (six of the seven reported cases) 13 with fatal outcome. A review of the nature of underlying medical conditions of the patients reported to have immune hemolytic anemia related to cephalosporins (as initially reported by Garratty et al 22 ) a frequent association of cefotetan (11 of 31 cases) with hemolysis in women who had obstetric/gynecologic conditions or interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Various combinations have been reported 4,8 . For example, among the nine reports of fatal outcome of second‐ and third‐generation cephalosporin–related intravascular immune hemolysis where information is available, four had IC only, 4,9,11,13 one had DA (cefoxitin) but data for IC were not reported, 4 three had DA and IC 4,7 (also Perkins J, Clay L. Written communication, January 1997), and one had all three mechanisms 6…”

Section: Discussionmentioning

confidence: 99%

“…However, since the appearance of the second‐ and third‐generation cephalosporins, there have been a small number of severe immune‐mediated hemolytic reactions reported, including 16 with a fatal outcome. Second‐generation agents associated with fatal reactions include cefotetan (Cefotan, Zeneca Pharmaceuticals, Wilmington, DE)—nine cases 4,6–8 (also: Perkins J, Clay L. written communication, January, 1997) and cefoxitin (Mefoxin, Merck and Co., West Point, PA)—one case 4 . The only third‐generation cephalosporin reported to be associated with hemolysis with fatal outcome is ceftriaxone (Rocephin, Roche Products, Inc., Nutley, NJ)—six cases 4,9–13 …”

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First two cases of immune hemolytic anemia associated with ceftizoxime

et al. 1999

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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First two cases of immune hemolytic anemia associated with ceftizoxime

et al. 1999

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Drug-induced hemolysis: Cefotetan-dependent hemolytic anemia mimicking an acute intravascular immune transfusion reaction

2000

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Numerous cases of drug-induced hemolytic anemia have been described in patients treated with penicillin or cephalosporin. Second and third generation cephalosporins are more commonly implicated in hemolytic reactions than first generation cephalosporins. We report a case of severe cefotetan-induced hemolytic anemia in a previously healthy 46-year-old woman undergoing an elective hysterectomy. The patient received 2 g of intravenous cefotetan intraoperatively and subsequently at 12 and 24 h post-operatively. She complained of diarrhea and fever on the third post-operative day and was seen in her gynecologist's office on the fifth post-operative day (hemoglobin = 10.5 g/dL). On the seventh post-operative day, she complained of fever and soreness around the suprapubic catheter site and was given a prescription for 500 mg oral cephalexin four times a day. The next day she was seen in the gynecologist's office and reported feeling better. Ten days after the operation her fatigue worsened and her hemoglobin was 4.8 g/dL. She was transfused with 3 units of packed red blood cells (PRBC) and was given 1 g of cefotetan intravenously. During the transfusion of the second unit of PRBC nursing staff observed gross hemoglobinuria and she subsequently developed acute renal failure. Laboratory chemistry parameters were consistent with severe acute hemolysis. The patient's direct antiglobulin test was reactive and her serum reacted with cefotetan-coated red blood cells (RBCs) and serum plus soluble cefotetan reacted with untreated RBCs. The titration endpoint of the serum against cefotetan-coated RBCs was 40,960, while the serum plus soluble cefotetan against uncoated RBCs was 2,560. This case of severe cefotetan-induced hemolysis was complicated by an acute hemolytic event that occurred during the transfusion of PRBC. Clinical and transfusion service staff must consider drug-induced hemolysis in the differential diagnosis of acute anemia.

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Drug-Induced Immune Hemolytic Anemia

Petz

2004

Immune Hemolytic Anemias

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A Rapidly Fatal Case of Immune Haemolytic Anaemia due to Cefotetan

Cited by 10 publications

References 5 publications

First two cases of immune hemolytic anemia associated with ceftizoxime

First two cases of immune hemolytic anemia associated with ceftizoxime

Drug-induced hemolysis: Cefotetan-dependent hemolytic anemia mimicking an acute intravascular immune transfusion reaction

Drug-Induced Immune Hemolytic Anemia

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