Case Report: First Case of Cefotaxime-Sulbactam-Induced Acute Intravascular Hemolysis in a Newborn With ABO Blood Type Incompatibility by the Mechanism of Non-Immunologic Protein Adsorption

Abstract

BackgroundABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN.Case presentationWe report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother’s blood type was O and RhD-positive, and the newborn’s blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother’s plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent. In vitro experiments confirmed that NIPA of SBT promoted the specific binding of maternal-derived IgG anti-B to B antigen on RBCs of the newborn, thereby inducing acute intravascular hemolysis.ConclusionThe NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn’s plasma to the newborn’s RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.

The First-Reported Case of Drug-Induced Hemolytic Anemia by Piperacillin-Tazobactam in a Premature Neonate: A Case Report and Literature Review

“…The more probable cause is non-immunologic protein adsorption (NIPA) due to transplacental maternal antibody reaction with RBCs caused by tazobactam adsorption. In a previous study, a comparable unfavorable occurrence was reported with sulbactam, which led to the death of a neonate as a result of hemolysis caused by non-immunologic protein adsorption (NIPA) [ 15 ]. Cephalosporins' similar mechanism of DIHA is noteworthy, but it is unlikely to have contributed to this hemolysis, as it was discontinued seven days prior [ 9 ].…”

Piperacillin-tazobactam induced immune hemolytic anemia led to increased renal impairment and eventual death from multiple organ failure in a patient with hypertensive nephropathy: case report and literature review

“…We recently reported a case of severe acute intravascular hemolysis in a neonate with ABO-incompatible hemolytic disease of the newborn following administration of cefotaxime-sulbactam. It was confirmed that the NIPA effect of sulbactam promoted the specific binding of maternally derived incompatible ABO blood group antibodies with the neonatal RBC blood group antigen, thereby activating complement [ 11 ]. Both tazobactam and sulbactam are β-Lactamase inhibitors with NIPA effect.…”

Microspheres with 2D rGO/Alginate Matrix for Unusual Prolonged Release of Cefotaxime

“…CTX is effective against a variety of bacterial strains that cause septicemia, lower respiratory tract, urinary tract, skin, soft tissue, bone, joints, and central nervous system infections. Furthermore, CTX is commonly administered intravenously or intramuscularly in dosing form, not available as an oral, medical batch bandage for skin or topical uses [5][6][7]. In general, the efficacy of cephalosporin as an antibiotic group is well-known without oral or well-established sustained-release encapsulation form compared to other antibiotic groups [8].…”