title: Ceftizoxime-induced hemolysis secondary to combined drug adsorption and immune-complex mechanisms.
abstract: BACKGROUND
  Immune hemolytic anemia has been associated with the administration of various antibiotics, including cephalosporins. Presented here is a patient who developed severe acute hemolysis while receiving ceftizoxime (Ceftizox, Fujisawa USA), a third-generation cephalosporin. This is the fourth reported case of hemolysis in association with ceftizoxime. In the previous cases, ceftizoxime was shown to induce hemolysis by the immune-complex mechanism. However, in one of those reports, the concentration of drug used to treat the target RBCs in vitro may not have been optimal.
  
  
  METHODS
  The patient's antemortem blood samples were analyzed retrospectively for drug-dependent antibodies by the drug-adsorption and immune-complex methods. Antibody class and titer were evaluated.
  
  
  RESULTS
  The patient's sample agglutinated RBCs coated with ceftizoxime as well as uncoated RBCs in the presence of ceftizoxime. The antibodies to ceftizoxime were IgM and IgG.
  
  
  CONCLUSIONS
  This is the first report on both the immune-complex and drug-adsorption mechanisms of ceftizoxime-induced hemolysis. The differential diagnosis of a falling Hct in a patient receiving antibiotics should include drug-related hemolysis; once this diagnosis is considered, management includes the appropriate serologic workup, immediate cessation of the implicated drugs, and possible transfusion support.
authors.affiliation: Department of Pathology (Blood Bank), The University of Chicago, Chicago, IL 60637, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Calhoun
authors.forename: T
authors.initials: T
authors.lastname: Junsanto
authors.forename: M T
authors.initials: MT
authors.lastname: Donoghue
authors.forename: E
authors.initials: E
authors.lastname: Naureckas
authors.forename: J M
authors.initials: JM
authors.lastname: Baron
authors.forename: B W
authors.initials: BW
authors.lastname: Baron
mesh_terms: D000327:Adsorption / Q000187:drug effects; D000368:Aged; D000936:Antigen-Antibody Complex / Q000276:immunology; D015296:Ceftizoxime / Q000493:pharmacokinetics* / Q000494:pharmacology*; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000145:classification; D008297:Male
chemical_list: D000936:Antigen-Antibody Complex; D007518:Isoantibodies; D015296:Ceftizoxime