Ceftizoxime-induced hemolysis secondary to combined drug adsorption and immune-complex mechanisms

BACKGROUND: Immune hemolytic anemia has been associated with the administra tion of various antibiotics, including cephalosporins. Presented here is a patient who developed severe acute hemolysis while receiving ceftizoxime (C eftizox, Fujisawa USA), a third-generation cephalosporin. This is the fourt h reported case of hemolysis in association with ceftizoxime. In the previo us cases, ceftizoxime was shown to induce hemolysis by the immune-complex m echanism. However, in one of those reports, the concentration of drug used to treat the target RBCs in vitro may not have been optimal. CASE REPORT: The patient's antemortem blood samples were analyzed retrospec tively for drug-dependent antibodies by the drug-adsorption and immune-comp lex 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 cef tizoxime were IgM and IgG. CONCLUSION: This is the first report on both the immune-complex and drug-ad sorption mechanisms of ceftizoxime-induced hemolysis. The differential diag nosis of a falling Hct in a patient receiving antibiotics should include dr ug-related hemolysis; once this diagnosis is considered, management include s the appropriate serologic workup, immediate cessation of the implicated d rugs, and possible transfusion support.