Risk of piperacillin‐induced hemolytic anemia in patients with cystic fibrosis and antipseudomonal treatment: a prospective observational study

Roehmel, Jobst; Specht, P.; Staab, Doris; Schwarz, C.; Salama, Abdulgabar; Mayer, Beate

doi:10.1111/trf.15591

Cited by 9 publications

(10 citation statements)

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“…With the exception of tazobactam, which causes IHA via the nonionic protein absorption pathway, all other drugs cause IHA via the drug-dependent antibody pathway. 15,26,27 Using FAERS database data for disproportionality analysis, we identified some rarely reported drugs, such as lisdexamfetamine, escitalopram, diazepam, aripiprazole, ribavirin, quetiapine, buprenorphine, ribavirin, and peginterferon alfa-2a. Although these drugs might cause IHA rarely, they still should be of concern.…”

Section: Discussionmentioning

confidence: 99%

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A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System

Tang

Ding

et al. 2023

Ann Pharmacother

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Background: Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening pharmacogenic hematological adverse effect. Updating the risk of DIIHA among the currently available drugs based on spontaneously reported adverse event data is of great significance. Objective: This study aimed to identify the top 50 drugs associated with immune hemolytic anemia in adults as well as common drugs that could cause immune hemolytic anemia in children based on the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. Methods: We extracted adverse events (AE) in the FAERS database from Q1 2004 to Q3 2022 using Open vigil2.1. We use the high-level term “anaemias haemolytic immune” according to the Medical Dictionary for Regulatory Activities (MedDRA) Dictionary (version 24.0). The reported correlation between drugs and DIIHA risk was identified by reported odds ratio (ROR) and proportional reporting ratio (PRR). Results: There were 10500309 AEs in FAERS from 2004Q1 to 2022Q3, of which 2326 (0.02%) were DIIHA cases. The incidence of DIIHA is comparable between males and females. The most common drugs associated with DIIHA in adults and children are summarized according to the number of AE reports. The top 3 categories in terms of quantity of drugs are antineoplastic agents, immunosuppressants, and antibiotics for systemic use. The top 5 drugs in terms of ROR and PRR are alemtuzumab, daclizumab, fludarabine, busulfan, and bendamustine in adults, with entecavir, treosulfan, vinorelbine, pegademase, and alemtuzumab for children. Conclusions: Our study identified the most common drugs that could induce DIIHA in adults and children, as well as the respective ROR and PRR value to discover new drug signals. This study provides references to clinicians for the management of rare DIIHA.

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Section: Discussionmentioning

confidence: 99%

“…With the exception of tazobactam, which causes IHA via the nonionic protein absorption pathway, all other drugs cause IHA via the drug-dependent antibody pathway. 15,26,27…”

Section: Discussionmentioning

confidence: 99%

A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System

Tang

Ding

et al. 2023

Ann Pharmacother

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“…A review of prior studies and reports showed that piperacillin-tazobactam-induced hemolytic anemia is more common in patients with cystic fibrosis, which may be attributed to their repeated exposure to recurrent infections [ 6 , 7 ]. A recent study has reported an instance of piperacillin-tazobactam-induced pancytopenia in a neonate.…”

Section: Discussionmentioning

confidence: 99%

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

Salim¹,

Musmar²,

Sarhan³

et al. 2023

Cureus

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Drugs can have a wide array of effects on hematological cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets. Drug-induced hemolytic anemia (DIHA) can be explained by three different pathophysiological mechanisms. We present a case of a premature neonate born at 34 weeks gestation who was admitted to the neonatal intensive care unit (NICU). He developed respiratory difficulty with mottled skin and was suspected to have bacterial sepsis due to necrotizing enterocolitis (NEC). The patient was eventually started on a broad-spectrum antibiotic, piperacillin-tazobactam. On day eight, the patient started developing jaundice and his hemoglobin level dropped from 12.1 to 8.2 mg/dL. His direct antiglobulin test (DAT) was strongly positive. The patient was suspected to have DIHA. Piperacillin-tazobactam is a commonly used antibiotic for neonatal sepsis, but its potential to cause DIHA in neonates is not well-established. Our case highlights the importance of considering piperacillin-tazobactam as an unrecognized contributor to neonatal jaundice and a potential cause of DIHA in neonates. Further research is needed to explore the extent of its involvement in this condition. Physicians should be cautious when administering this drug to neonates and be aware of the possibility of hemolysis and jaundice.

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“…Drug-induced immune hemolytic anemia (DIIHA) is a side effect of medication that can cause serious consequences. The annual incidence of DIIHA with obvious anemia is 1–4 per million people [ 1 – 3 ]. The mechanism of DIIHA is due to the immune damage to red blood cells (RBCs) caused by drug-induced antibodies (including drug-dependent antibodies and/or drug-independent antibodies) or non-immunologic protein adsorption (NIPA) [ 4 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wu¹,

Guo

et al. 2023

BMC Nephrol

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Background Piperacillin is one of the most common drugs that cause drug-induced immune hemolytic anemia, but a complete description of the serological features and course of the disease is rare. This study completely describes the serological characteristics and course of a patient with hypertensive nephropathy who developed drug-induced immune hemolytic anemia and worsened renal function during repeated administration of piperacillin-tazobactam. Case presentation A 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia and worsened renal function during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection. Serological tests showed that the result of the direct antiglobulin test for anti-IgG was positive (4 +) and anti-C3d was negative, and the irregular red blood cell antibody screening test was negative. Plasma samples collected at different times from 2 days before to 12 days after the discontinuation of piperacillin-tazobactam administration were incubated with piperacillin solution and red blood cells of O-type healthy blood donors at 37 °C, IgG piperacillin-dependent antibodies were detected, and the highest titer was 128. However, no tazobactam-dependent antibody was detected in any plasma samples. Therefore, the patient was diagnosed with piperacillin-induced immune hemolytic anemia. Although blood transfusion and continuous renal replacement therapy were given, the patient died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped. Conclusion This is the first complete description of the disease course and serological changes of piperacillin-induced immune hemolytic anemia, which is bound to help deepen the understanding of drug-induced immune hemolytic anemia and draw profound lessons from it.

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Risk of piperacillin‐induced hemolytic anemia in patients with cystic fibrosis and antipseudomonal treatment: a prospective observational study

Cited by 9 publications

References 50 publications

A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System

A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System

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

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

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