Extravascular hemolysis following the administration of cefamandole

Abstract

Hemolytic anemia occurred in a 70-year-old female after a five-day course of intravenous cefamandole. The patient's serum contained an IgG antibody which was reactive with red blood cells which had been coated in vitro with cefamandole but not with uncoated cells. An in vitro assay of allogeneic mononuclear phagocytosis of cefamandole-coated red cells sensitized with the patient's anti-cefamandole indicated that the anti-cefamandole could induce significant phagocytosis. The anti-cefamandole was easily inhibited in vitro by cefamandole as well as by a variety of related cephalosporins indicating broad cross-reactivity, with the antigenic site primarily the 7-amino-cephalosporanic acid nucleus. Penicillins could inhibit the anti-cefamandole but only when using concentrations 3-10 X those of cephalosporins. Eleven examples of anti-penicillin tested failed to react with cefamandole-coated red cells. Screening of 344 random sera from hospitalized patients found only five (1.5%) reactive with cefamandole-coated red cells; three of these sera were also reactive with penicillin-coated red cells. The patient's hemolysis subsided following cessation of the drug. This is the first report of anti-cefamandole-induced hemolytic anemia.

Drug-Induced Immune Hemolytic Anemia

“…[183][184][185][186] All five of these cases were associated with cephalothin (one of these cases was also associated with cefazolin). 187,300 The serologic evidence in both these reports was not very convincing. 298,299 Second-generation cephalosporins began to be used in the late 1970s, but until 1987 there were only two case reports of a patient having IHA associated with their usage; these were due to cefoxitin and cefamandole.…”

Serology of antibodies to second‐ and third‐generation cephalosporins associated with immune hemolytic anemia and/or positive direct antiglobulin tests

“…Third‐generation cephalosporins started appearing in 1981: cefotaxime in 1981, ceftriaxone in 1984; and ceftazidime in 1985. In 1985, the first report of IHA associated with second‐generation cephalosporins appeared, a not‐very‐convincing case of IHA said to be caused by cefamandole 6 …”