title: Immune-mediated severe hemolytic crisis with a hemoglobin level of 1.6 g/dl caused by anti-piperacillin antibodies in a patient with cystic fibrosis.
abstract: We report a 23-year-old female patient with cystic fibrosis developing severe intravascular hemolysis with a minimal hemoglobin level of 1.6 g/dl after 7 days of treatment with piperacillin, consistent with an immune-mediated hemolytic crisis. Twenty days later, the patient could leave the hospital in good condition without any neurological deficit. To our knowledge, this is the lowest reported hemoglobin value caused by hemolytic anemia with intact survival. As piperacillin is commonly used in patients with cystic fibrosis, it is important to monitor the full-blood counts of patients during treatment with piperacillin and to be aware of the potential for hemolytic anemia to develop. Anti-piperacillin antibodies should be considered whenever these patients develop hemolytic anemia or a positive direct antiglobulin test (DAT). Furthermore, drug-fever under piperacillin application could be a warning sign for the development of hemolytic anemia.
authors.affiliation: University Children's Hospital, University of Würzburg, Josef-Schneider Str. 2, 97080 Würzburg, Germany. kunzmann_s@kinderklinik.uni-wuerzburg.de
authors.forename: S
authors.initials: S
authors.lastname: Kunzmann
authors.forename: W
authors.initials: W
authors.lastname: Thomas
authors.forename: B
authors.initials: B
authors.lastname: Mayer
authors.forename: S
authors.initials: S
authors.lastname: Kuhn
authors.forename: H
authors.initials: H
authors.lastname: Hebestreit
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003550:Cystic Fibrosis / Q000150:complications* / Q000188:drug therapy*; D004342:Drug Hypersensitivity; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D010878:Piperacillin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D006454:Hemoglobins; D010878:Piperacillin