Thrombocytopenia Caused by Cephalothin Sodium

Abstract

Thrombocytopenia due to use of cephalothin sodium developed in an individual with a history of sensitivity to penicillin and no prior exposure to cephalothin. The in vitro studies bore out the clinical impression of cephalothin-induced thrombocytopenia, although hemagglutinating techniques failed to demonstrate erythrocyte-related antibodies to either penicillin or cephalothin. There is a possible but not proved relationship between penicillin sensitivity and cephalothin sensitivity. Patients receiving cephalothin should be observed carefully for blood dyscrasia.REACTIONS DUE to sensitivity to the cephalosporins have been noted especially in individuals known to be sensitive to penicillin.1 Review of the literature fails to reveal any report of thrombocyto-penia caused by this drug. Neutropenia has been reported, but this has been a brief and minor phe¬ nomenon. We present a case of thrombocytopenia with severe clinical bleeding which occurred follow¬ ing the administration of cephalothin sodium to an individual with prior sensitivity to penicillin. The in vitro studies performed bear out the causal re¬ lationship between the administration of the drug and the hématologie abnormality.Report of a Case A 78-year-old white woman was hospitalized on Jan 2, 1967, after the sudden onset of pains in the upper region of the abdomen, fever, nausea, and vomiting. Her past history consisted of an appendectomy and a hysterectomy. She also admitted to a generalized rash following ingestion of peni¬ cillin. Physical examination revealed a moderately ill, febrile woman with tenderness in the upper portion of the abdomen on the right and guarding but no rigidity. Chest and ab¬ dominal x-ray films were normal. The electrocardiogram showed nonspecific T-wave abnormalities. Hematocrit value was 41%; white blood cell count, 6,900/cu mm, with 66% polymorphonuclear leukocytes, 7% band forms, and 27% lymphocytes. Platelets were described as adequate on the blood smear. The blood urea nitrogen (BUN) level on ad¬ mission was 55 mg/100 ml. Determinations of serum elec¬ trolyte and amylase levels and liver-function studies gave normal results. The results of a routine urinalysis were normal except for 2+ albumin. The initial diagnosis was acute cholecystitis.The patient was treated with tetracycline until the blood culture showed the presence of Proteus mirabilis which was sensitive primarily to cephalothin and kanamycin. The BUN level had risen to 154 mg/100 ml. Cephalothin sodium was administered intravenously, 4.5 gm/24 hr. After 48 hours of therapy, microscopic hematuria was noted. This was fol¬ lowed by gross hematuria, diffuse ecchymoses, petechiae, and melena. The hematocrit value had fallen to 23% and the platelet count, to 42,000/cu mm from the previously de¬ scribed adequate numbers noted on the initial blood smear. The temperature had fallen to 100 F (37.8 C) and blood cultures had become sterile. The possibility of cephalothin induced thrombocytopenia prompted discontinuance of cephalothin and initiation of therapy with prednis...

Infectious diseases. Annual review of significant publications

“…48 Cephalothin induced thrombocytopenia in a patient sensitive to penicillin. 49 During a 2-month period, of eight patients who underwent open-heart surgery five developed respiratory tract infection with Ps. aeruginosa type 10 and three died.…”